Individual
DR. MICHELE LEE PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
817 GRIFFIN AVE, EASTMAN, GA 31023-6718
(478) 374-0020
(478) 374-2937
Mailing address
817 GRIFFIN AVE, EASTMAN, GA 31023-6718
(478) 374-0020
(478) 374-2937
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
063003
GA
207Q00000X
Family Medicine Physician
4301070192
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0801975377
RAILROAD MEDICARE
MI
01
—
0806346602
BCBS
MI
05
—
1093793622
—
MI
05
—
166083196D
—
GA
01
—
202I082364
MEDICARE (PTAN)
GA
Enumeration date
01/04/2006
Last updated
09/01/2010
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