Provider Demographics
NPI:1497913180
Name:FOOTHILLS EMERGENCY SERVICES, LLC
Entity Type:Organization
Organization Name:FOOTHILLS EMERGENCY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-746-6571
Mailing Address - Street 1:196 RIDGECREST CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-4111
Mailing Address - Country:US
Mailing Address - Phone:706-746-6571
Mailing Address - Fax:706-746-5643
Practice Address - Street 1:196 RIDGECREST CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4111
Practice Address - Country:US
Practice Address - Phone:706-746-6571
Practice Address - Fax:706-746-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700711Medicare PIN