P E T Imaging of Gwinnett LLC

Primary specialty

Body Imaging PhysicianTaxonomy code 2085B0100X

Legal business name

P E T IMAGING OF GWINNETT LLC

Doing business as

Trident PET of Gwinnett

Practice address

545 Old Norcross Rd
Ste 200
Lawrenceville, GA 30045-3389

Phone

(770) 719-3754

Fax

(770) 719-3804

NPI assigned

Sep 12, 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 Gwinnett Doing business as

Locations

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334016000000",
    "number": "1841285392",
    "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": "545 OLD NORCROSS RD",
            "address_2": "STE 200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453389",
            "telephone_number": "770-719-3754",
            "fax_number": "770-719-3804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P E T IMAGING OF GWINNETT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRIDENT MOLECULAR IMAGING, LLC",
        "enumeration_date": "2005-09-12",
        "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": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trident  PET of Gwinnett",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Anne Owens, CNM
• Anne Gyamfi Owusu, CRNA
• Oluwakemi Abiodun Oyedeji, PHARMACIST
• Rotimi Oyewole, P.T
• Nishith Oza, PT
• Lesley Pacateque
• Hannah Shalini Packiam, MD
• Erica M Padilla
• Emma Paduraru
• Paul Edward Pafford, DMD

• Body Imaging Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Body Imaging 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.