Healthcare Provider Details

I. General information

NPI: 1235190992
Provider Name (Legal Business Name): GEORGE W. PRIVETT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 HARRODSBURG RD SUITE 100
LEXINGTON KY
40504-3601
US

IV. Provider business mailing address

1725 HARRODSBURG RD SUITE 100
LEXINGTON KY
40504-3601
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-7226
  • Fax: 859-276-1540
Mailing address:
  • Phone: 859-278-7226
  • Fax: 859-276-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number14905
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: