Healthcare Provider Details

I. General information

NPI: 1750376208
Provider Name (Legal Business Name): PET IMAGING CENTER OF SAVANNAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 STEPHENSON AVE STE 101
SAVANNAH GA
31405-5838
US

IV. Provider business mailing address

PO BOX 249
BROOKS GA
30205-0249
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-7523
  • Fax: 912-355-7526
Mailing address:
  • Phone: 770-692-1387
  • Fax: 770-692-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier617511716B
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: GUY A MESSER
Title or Position: CEO
Credential:
Phone: 770-692-1387