Provider Demographics
NPI:1780034041
Name:PETTY, CHELSEA (RDMS, RVT, RDCS)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:PETTY
Suffix:
Gender:F
Credentials:RDMS, RVT, RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HILL TOP DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-1261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 E 15TH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3516
Practice Address - Country:US
Practice Address - Phone:706-534-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1685292471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography