Healthcare Provider Details
I. General information
NPI: 1336356120
Provider Name (Legal Business Name): GEORGE EMMETT PETTY III ARRT (R) (M) (CT)
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2155 E 23RD AVE S STE A
FREMONT NE
68025-7849
US
IV. Provider business mailing address
1613 SUMMIT DR
WAYNESBORO VA
22980-5231
US
V. Phone/Fax
- Phone: 866-784-2329
- Fax:
- Phone: 931-623-0979
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471C3401X |
| Taxonomy | Computed Tomography Radiologic Technologist |
| License Number | 0120004623 |
| License Number State | VA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471C3401X |
| Taxonomy | Computed Tomography Radiologic Technologist |
| License Number | 5381 |
| License Number State | TN |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471C3401X |
| Taxonomy | Computed Tomography Radiologic Technologist |
| License Number | R8858280 |
| License Number State | OH |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471C3401X |
| Taxonomy | Computed Tomography Radiologic Technologist |
| License Number | 363923 |
| License Number State | NY |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471C3401X |
| Taxonomy | Computed Tomography Radiologic Technologist |
| License Number | 639310 |
| License Number State | NJ |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471C3401X |
| Taxonomy | Computed Tomography Radiologic Technologist |
| License Number | R0007930 |
| License Number State | MD |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471C3401X |
| Taxonomy | Computed Tomography Radiologic Technologist |
| License Number | 10-121-14015 |
| License Number State | KY |
| # 8 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2471C3401X |
| Taxonomy | Computed Tomography Radiologic Technologist |
| License Number | RHF 77185 |
| License Number State | CA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471M1202X |
| Taxonomy | Magnetic Resonance Imaging Radiologic Technologist |
| License Number | 0120004623 |
| License Number State | VA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471M1202X |
| Taxonomy | Magnetic Resonance Imaging Radiologic Technologist |
| License Number | 5381 |
| License Number State | TN |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471M1202X |
| Taxonomy | Magnetic Resonance Imaging Radiologic Technologist |
| License Number | R8858280 |
| License Number State | OH |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471M1202X |
| Taxonomy | Magnetic Resonance Imaging Radiologic Technologist |
| License Number | 363923 |
| License Number State | NY |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471M1202X |
| Taxonomy | Magnetic Resonance Imaging Radiologic Technologist |
| License Number | 639310 |
| License Number State | NJ |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471M1202X |
| Taxonomy | Magnetic Resonance Imaging Radiologic Technologist |
| License Number | R0007930 |
| License Number State | MD |
| # 15 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2471M1202X |
| Taxonomy | Magnetic Resonance Imaging Radiologic Technologist |
| License Number | 5302 |
| License Number State | DE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
