Provider Demographics
NPI:1669471926
Name:PENNINGTON, GEORGE P (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1795
Mailing Address - Country:US
Mailing Address - Phone:229-247-2122
Mailing Address - Fax:229-247-4314
Practice Address - Street 1:2704 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1744
Practice Address - Country:US
Practice Address - Phone:229-247-2122
Practice Address - Fax:229-247-4314
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031814208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02BDBQFMedicare ID - Type Unspecified
GAD53415Medicare UPIN