Individual
ELAINE PENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
4249 OLD ALABAMA RD, THOMASTON, GA 30286-3270
(706) 647-4514
Mailing address
4249 OLD ALABAMA RD, THOMASTON, GA 30286-3270
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT000228
GA
Other
Enumeration date
11/11/2006
Last updated
07/08/2007
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