# MOUNTAIN VALLEY MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891954178
- **Authorized official:** CHARLES R PENNINGTON MD (ADMINISTRATOR)
- **Authorized official phone:** (706) 746-6571

## Contact information

- **Practice address:** 92 BETTYS CREEK RD, DILLARD, GA 30537-2257
- **Practice address phone:** (706) 746-6571
- **Practice address fax:** (706) 746-5643
- **Mailing address:** PO BOX 444, DILLARD, GA 30537-0444
- **Mailing address phone:** (706) 746-6571
- **Mailing address fax:** (706) 746-5643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 025380 | GA | Yes |

## Other

- **Enumeration date:** 06/03/2008
- **Last updated:** 03/18/2009