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General NPI Number Information
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NPI Number | 1598132995
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Entity Type | Individual
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Provider Name | PAUL F PENN JR. DC
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Gender | Male
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 3433 MAIN ST B
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City | COLLEGE PARK
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State | GA
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Zip | 30337-1911
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Country | US
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Telephone | 404-766-0676
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1219
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City | PALMETTO
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State | GA
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Zip | 30268-7219
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Country | US
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Telephone | 404-766-0676
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Fax |
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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 | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | CHIR002655
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License Number State | GA
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