Organization
JACK W PENNINGTON MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK W PENNINGTON MD (PHYSICIAN/OWNER)
(706) 745-5758
Entity
Organization
Contact information
Practice address
207 HOSPITAL CIR, SUITE A, BLAIRSVILLE, GA 30512-3128
(706) 745-5758
(706) 745-1211
Mailing address
207 HOSPITAL CIR, SUITE A, BLAIRSVILLE, GA 30512-3128
(706) 745-5758
(706) 745-1211
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89066U5
—
NC
Enumeration date
03/11/2008
Last updated
03/11/2008
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