Mountain Valley Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

025380 Issued in GA

Legal business name

MOUNTAIN VALLEY MEDICAL CENTER

Practice address

92 Bettys Creek Rd
Dillard, GA 30537-2257

Phone

(706) 746-6571

Fax

(706) 746-5643

NPI assigned

Jun 3, 2008

Last updated

Mar 18, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Charles R Pennington, MDNPI 1669589594

Title

Administrator

Phone

(706) 746-6571

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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.

• Charles Royce Pennington, M.D.

  • Family Medicine Physician
  • Dillard, GA
  • NPI 1669589594
  NPD (past) Authorized official
• Addis Daniel Windham, MD

  • Diagnostic Radiology Physician
  • Sautee, GA
  • NPI 1184884793
  NPD (past)

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237334400000",
    "number": "1891954178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 444",
            "city": "DILLARD",
            "state": "GA",
            "postal_code": "305370444",
            "telephone_number": "706-746-6571",
            "fax_number": "706-746-5643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 BETTYS CREEK RD",
            "city": "DILLARD",
            "state": "GA",
            "postal_code": "305372257",
            "telephone_number": "706-746-6571",
            "fax_number": "706-746-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN VALLEY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2009-03-18",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-746-6571",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "025380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00273831B4",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raymond Gyselinck Jr, DDS
• Health First (Mountain Valley Medical Center)
• Health First (Mountain Valley Medical Center)
• Charlotte Jessandra Jones, DC
• Mason Sawyer DMD LLC (Foothills Dentistry)
• Charles Royce Pennington, M.D.
• Traces Trinity, LLC
• Richard Howe Vollmer, DDS

• Family Medicine Physician in Dillard, GA
• Providers in Dillard, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2009; 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.