MEDICARE: DANIEL LEE PENNINGTON BSW

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
1	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1710026109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL LEE PENNINGTON BSW

Provider Business Mailing Address
First Line	:	PO BOX 9054
Second Line	:
City	:	GRAY
State	:	TN
Zip	:	37615-9054
Country	:	US
Telephone Number	:	423-467-3600
Fax Number	:	423-467-3644

Provider Business Practice Location Address
First Line	:	808 FRANK JONES RD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2232
Country	:	US
Telephone Number	:	423-461-7750
Fax Number	:	423-461-7753

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	09/11/2025

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