| Bruce R Penn Inc | |
|
5165 Lavista Rd Tucker GA 30084-3602 | |
| (770) 908-1746 | |
| Not Available |
| Full Name | Bruce R Penn Inc |
|---|---|
| Speciality | Social Worker |
| Location | 5165 Lavista Rd, Tucker, Georgia |
| Authorized Official Name and Position | Nancy F Penn (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7709081746 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce R Penn Inc 4378 Sleepy Hollow Cv Lilburn GA 30047-4196 Ph: () - | Bruce R Penn Inc 5165 Lavista Rd Tucker GA 30084-3602 Ph: (770) 908-1746 |
| NPI Number | 1023255684 |
|---|---|
| Provider Enumeration Date | 01/19/2009 |
| Last Update Date | 01/19/2009 |
| Medicare PECOS PAC ID | 0244643112 |
|---|---|
| Medicare Enrollment ID | O20210114000267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023255684 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW002606 (Georgia) | Primary |
| Provider Name | Nancy F Penn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053479113 PECOS PAC ID: 6800999186 Enrollment ID: I20070306000497 |
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