Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CHIR002655 | GA |
NPI | 1598132995 |
---|---|
Provider Name | Paul F Penn JR. |
First Address | Palmetto, GA 30268-7219 |
Second Address | College Park, GA 30337-1911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2015 |
Last Update Date | 01/09/2015 |