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NPI Code Detail

MEDICARE: FOOTHILLS EMERGENCY SERVICES, LLC

MEDICARE: FOOTHILLS EMERGENCY SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1497913180
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOOTHILLS EMERGENCY SERVICES, LLC
Provider Business Mailing Address
First Line : 196 RIDGECREST CIR
Second Line :
City : CLAYTON
State : GA
Zip : 30525-4111
Country : US
Telephone Number : 706-746-6571
Fax Number : 706-746-5643
Provider Business Practice Location Address
First Line : 196 RIDGECREST CIR
Second Line :
City : CLAYTON
State : GA
Zip : 30525-4111
Country : US
Telephone Number : 706-746-6571
Fax Number : 706-746-5643
Authorized Official
Title or Position : SECRETARY
Name : CHARLES R PENNINGTON
Credential : M.D.
Telephone Number : 706-746-6571
Provider Enumeration Date : 05/29/2008
Last Update Date : 09/03/2008

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Directions to “FOOTHILLS EMERGENCY SERVICES, LLC ” Practice Location

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