Individual provider Active NPI

Caroline McCall Pennycook, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1780460808
Registry record updated Feb 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11815 Issued in GA
Practice address
1100 Johnson Ferry Rd NE
Atlanta, GA 30342-1709
Phone
(404) 250-6691
Fax
(404) 250-8847
NPI assigned
Sep 5, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 11815 GA Primary

Addresses

Primary practice location

1100 Johnson Ferry Rd NE
Atlanta, GA 30342-1709

Mailing address

1100 Johnson Fy Rd NE
Atlanta, GA 30342-1709
Phone (404) 250-6691

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231129002874 GA Practitioner - Physician Assistant 5294183331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Surgical Professional Services LLCGroup PAC ID 8628253424, 367 clinicians

Practice addresses (Care Compare)

1000 Johnson Ferry NE
Atlanta, GA 30342-1606

1000 Johnson Ferry Rd NE
Atlanta, GA 30342-1606
Phone (404) 851-8000

1100 Johnson Ferry Rd
Suite 410
Atlanta, GA 30342-1709
Phone (404) 847-0664

1200 Northside Forsyth Dr
Cumming, GA 30041-7659
Phone (770) 844-3200

3215 McClure Bridge Rd
Duluth, GA 30096-3223
Phone (404) 250-6691

3620 Howell Ferry Rd
Duluth, GA 30096-3178
Phone (678) 312-6800

450 Northside Cherokee Blvd
Canton, GA 30115-8015
Phone (770) 224-1000

470 Northside Cherokee Blvd
Canton, GA 30115-8029

Hospital & facility affiliations

  • Northside Hospital Forsyth Hospital, Cumming, GA, CCN 110005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11815GAMDPhysician Assistant

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771113600000",
    "number": "1780460808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 JOHNSON FY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421709",
            "telephone_number": "404-250-6691",
            "fax_number": "404-250-8847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 JOHNSON FERRY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421709",
            "telephone_number": "404-250-6691",
            "fax_number": "404-250-8847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNYCOOK",
        "first_name": "CAROLINE",
        "middle_name": "MCCALL",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-05",
        "last_updated": "2026-02-15",
        "certification_date": "2026-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.