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General NPI Number Information
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NPI Number | 1730334079
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Entity Type | Individual
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Provider Name | RICHARD GEORGE PETTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 2430 TUCKER DR BLDG A
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City | LOGANVILLE
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State | GA
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Zip | 30052-4390
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Country | US
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Telephone | 770-554-8812
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Fax |
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Provider Business Mailing Address
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Address Line | 2430 TUCKER DR BLDG A
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City | LOGANVILLE
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State | GA
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Zip | 30052-4390
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Country | US
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Telephone | 770-554-8812
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD052287L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AK000401L
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License Number State | PA
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