Jack Wayne Pennington, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

015212 Issued in GA

Practice address

207 Hospital Cir
Suite a
Blairsville, GA 30512-3128

Phone

(706) 745-5758

Fax

(706) 745-1211

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871676627",
    "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": {
        "last_name": "PENNINGTON",
        "first_name": "JACK",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "015212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Blairsville, GA
• Providers in Blairsville, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.