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General NPI Number Information
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NPI Number | 1326139627
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Entity Type | Organization
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Legal Business Name | PENN TECK DIAGNOSTICS INC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 05/26/2011
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Provider Practice Location Address
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Address Line | 820 ST. SEBASTIAN WAY, SUITE 2B
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City | AUGUSTA
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State | GA
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Zip | 30901
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Country | US
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Telephone | 706-722-6612
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Fax | 706-722-5057
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Provider Business Mailing Address
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Address Line | 820 ST. SEBASTIAN WAY, SUITE 2B
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City | AUGUSTA
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State | GA
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Zip | 30901
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Country | US
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Telephone | 706-722-6612
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Fax | 706-722-5057
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WEEMS R PENNINGTON JR.
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Credential | MD
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Telephone | 706-722-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 014977
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License Number State | GA
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