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General NPI Number Information
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NPI Number | 1255562948
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA COLON AND RECTAL SURGERY, LLC
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 3890 JOHNS CREEK PKWY SUITE 320
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City | SUWANEE
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State | GA
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Zip | 30024-1284
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Country | US
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Telephone | 678-954-8538
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Fax |
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Provider Business Mailing Address
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Address Line | 3890 JOHNS CREEK PKWY SUITE 320
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City | SUWANEE
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State | GA
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Zip | 30024-1284
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Country | US
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Telephone | 678-954-8538
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | E EARL PENNINGTON
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Credential | MD
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Telephone | 678-954-8538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 015299
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License Number State | GA
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