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General NPI Number Information
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NPI Number | 1144247099
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Entity Type | Individual
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Provider Name | AMANDA MARIE PENNINGTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 1656 RIVERCHASE BLVD
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City | ROCK HILL
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State | SC
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Zip | 29732-1724
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Country | US
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Telephone | 803-329-5131
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Fax | 803-366-6600
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Provider Business Mailing Address
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Address Line | PO BOX 602120
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City | CHARLOTTE
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State | NC
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Zip | 28260-2120
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Country | US
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Telephone | 803-329-5131
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Fax | 803-366-6600
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20333
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9300562
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License Number State | NC
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