Provider Demographics
NPI:1366541187
Name:PENNINGTON, WEEMS R JR (MD)
Entity type:Individual
Prefix:
First Name:WEEMS
Middle Name:R
Last Name:PENNINGTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903
Mailing Address - Country:US
Mailing Address - Phone:803-215-1502
Mailing Address - Fax:706-722-1947
Practice Address - Street 1:820 ST. SEBASTIAN WAY SUITE 2A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:803-215-1502
Practice Address - Fax:706-722-1947
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14977174400000X, 207RC0000X, 207R00000X
SC18530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00094179AMedicaid
SC906988Medicaid
GA1223Medicare PIN