Active NPI
Justin Paul Pennington, DMD
- General Practice Dentistry
- Midway, GA
National Provider Identifier
1225523582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN015706
- Practice address
- 28 Butler St
Midway, GA 31320-4294 - Phone
- (912) 880-2288
- NPI assigned
- Jun 28, 2018
- Last updated
- Jun 28, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN015706 | GA | Primary |
Addresses
Primary practice location
28 Butler St
Midway, GA 31320-4294
Mailing address
120 Longleaf Cir
Pooler, GA 31322-9388
Phone (678) 559-5353
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN015706 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midway Family Dental | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530144000000",
"number": "1225523582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 LONGLEAF CIR",
"city": "POOLER",
"state": "GA",
"postal_code": "313229388",
"telephone_number": "678-559-5353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 BUTLER ST",
"city": "MIDWAY",
"state": "GA",
"postal_code": "313204294",
"telephone_number": "912-880-2288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNINGTON",
"first_name": "JUSTIN",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-28",
"last_updated": "2018-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN015706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midway, GA
- Jennifer Neal, R.N.
- Optim Orthopedics, LLC (Optim Orthopedics)
- Traiana Daciana Pacurar, M.D.
- Angela Parr
- Harnish Patel, RPH
- Marissa Lynn Peterson, RN, CNM
- Prime Care Medical Services Inc
- Puzzling Patterns (Puzzling Patterns Behavior Therapy and Consultation Services)
- Jamie L Redding, BCBA
- Gloria Reese
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.