Provider Demographics
NPI:1215027263
Name:PENNINGTON, WEEMS R III (MD)
Entity Type:Individual
Prefix:DR
First Name:WEEMS
Middle Name:R
Last Name:PENNINGTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATT: IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:803-641-4874
Mailing Address - Fax:
Practice Address - Street 1:137 MIRACLE DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6351
Practice Address - Country:US
Practice Address - Phone:803-641-4874
Practice Address - Fax:803-641-0436
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59309207RC0000X, 207RC0000X
SC22253207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG59309Medicaid
SCH857103806Medicare PIN