NPIMap

Organization Active NPI

Jack W Pennington MD LLC

  • Clinic/Center
  • Blairsville, GA
National Provider Identifier
1851561492
Registry record updated Mar 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
JACK W PENNINGTON MD LLC
Practice address
207 Hospital Cir
Suite a
Blairsville, GA 30512-3128
Phone
(706) 745-5758
Fax
(706) 745-1211
NPI assigned
Mar 11, 2008
Last updated
Mar 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2008

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

Authorized official

Name
Jack W Pennington, MDNPI 1871676627
Title
Physician/Owner
Phone
(706) 745-5758

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

207 Hospital Cir
Suite a
Blairsville, GA 30512-3128

Mailing address

207 Hospital Cir
Suite a
Blairsville, GA 30512-3128
Phone (706) 745-5758

Other identifiers 1

IdentifierTypeStateIssuer
89066U5MedicaidNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1851561492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 HOSPITAL CIR",
            "address_2": "SUITE A",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305123128",
            "telephone_number": "706-745-5758",
            "fax_number": "706-745-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 HOSPITAL CIR",
            "address_2": "SUITE A",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305123128",
            "telephone_number": "706-745-5758",
            "fax_number": "706-745-1211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK W PENNINGTON MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "706-745-5758",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89066U5",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blairsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.