Individual
DEREK PAUL PENDARVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(770) 536-2323
(770) 536-4947
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 535-7445
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
049933
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000904274A
—
GA
05
—
000904274B
—
GA
01
—
10045029
AMERIGROUP
GA
01
—
1700231
UNITED HEALTHCARE
GA
01
—
20050660
RR MEDICARE-GRP # CC4177
GA
01
—
341106
WELLCARE
GA
01
—
52843776
BCBS
GA
01
—
7816063
CIGNA
GA
Enumeration date
01/18/2006
Last updated
05/22/2024
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