Organization
MOUNTAIN VALLEY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES R PENNINGTON MD (ADMINISTRATOR)
(706) 746-6571
Entity
Organization
Contact information
Practice address
92 BETTYS CREEK RD, DILLARD, GA 30537-2257
(706) 746-6571
(706) 746-5643
Mailing address
PO BOX 444, DILLARD, GA 30537-0444
(706) 746-6571
(706) 746-5643
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
025380
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00273831B4
—
GA
Enumeration date
06/03/2008
Last updated
03/18/2009
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