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General NPI Number Information
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NPI Number | 1376034983
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Entity Type | Individual
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Provider Name | LEE PENNINGTON MCNICHOLS NP
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Gender | Female
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 12460 CRABAPPLE RD. SUITE 202- 313
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City | ALPHARETTA
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State | GA
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Zip | 30004-6646
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Country | US
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Telephone | 770-727-1167
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Fax | 404-819-7660
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Provider Business Mailing Address
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Address Line | 12460 CRABAPPLE RD., SUITE 202-313
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City | ALPHARETTA
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State | GA
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Zip | 30004-6646
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Country | US
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Telephone | 770-727-1167
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Fax | 404-393-7788
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | RN129155
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License Number State | GA
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