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Individual

GEORGE LYCURGLUS PETTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1314 19TH AVE, MERIDIAN, MS 39301
(205) 270-9467
Mailing address
1901 5TH AVE E UNIT 1113, TUSCALOOSA, AL 35401-3868
(205) 270-9467
(205) 348-5294

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
24118
MS
207QA0505X
Adult Medicine Physician
Primary
MD.34536
AL

Other

Enumeration date
05/24/2013
Last updated
08/24/2018
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