P E T Imaging of Fayette LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

P E T IMAGING OF FAYETTE LLC

Doing business as

Trident PET of Fayette

Practice address

1275 Highway 54 W
Ste 102
Fayetteville, GA 30214-4549

Phone

(770) 719-3754

Fax

(770) 719-3804

NPI assigned

Sep 16, 2005

Last updated

Apr 10, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

TRIDENT MOLECULAR IMAGING, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Guy A Messer

Title

Cfo

Phone

(770) 692-2371

Specialties & licenses 1

Addresses

Other names 1

• Trident PET of Fayette Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334016000000",
    "number": "1619962503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 HIGHWAY 54 W",
            "address_2": "STE 103",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144549",
            "telephone_number": "770-692-2371",
            "fax_number": "770-692-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 HIGHWAY 54 W",
            "address_2": "STE 102",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144549",
            "telephone_number": "770-719-3754",
            "fax_number": "770-719-3804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P E T IMAGING OF FAYETTE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRIDENT MOLECULAR IMAGING, LLC",
        "enumeration_date": "2005-09-16",
        "last_updated": "2012-04-10",
        "status": "A",
        "authorized_official_last_name": "MESSER",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-692-2371"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trident  PET of Fayette",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Denise Owens-Gilkesson, PHARMD
• Anofiu Owoseni
• J. Rena Owsley-Brown, DMD
• Adenike Oluwafunsho Oyedele, RN, BSN
• P & M Transportation
• P4 Physical Therapy Limited Partnership
• Tryphena Pacitti, NP
• Donna Page, DOULA
• Manjit Pakkala, MD
• Dawn Leilani Paletta, PA

• Diagnostic Radiology Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Diagnostic Radiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.