Individual
KEITH BRADLEY PENNYCOOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2870 RONALD REAGAN BLVD STE 103, CUMMING, GA 30041-6092
(248) 601-4900
Mailing address
2870 RONALD REAGAN BLVD STE 103, CUMMING, GA 30041-6092
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
86267
GA
Other
Enumeration date
04/15/2019
Last updated
12/19/2025
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