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General NPI Number Information
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NPI Number | 1629063722
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Entity Type | Individual
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Provider Name | JEFFREY CARL PENCE MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 175 WHITE ST NW STE 200
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City | MARIETTA
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State | GA
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Zip | 30060-7901
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Country | US
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Telephone | 943-202-7820
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Fax |
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Provider Business Mailing Address
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Address Line | 213 S JEFFERSON ST STE 1006
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City | ROANOKE
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State | VA
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Zip | 24011-1713
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Country | US
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Telephone | 540-224-5352
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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 | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 9500178
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 35.092404
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 0101277715
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | 2086S0120X
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License Number State | GA
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