| Doctor Name: | DR. TIMOTHY CLINARD PENNELL |
| NPI Number: | 1255684130 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 11924 |
| Business Practice Address: | 5401 Covenant Ln Winston Salem, NC - 271066459 |
| Business Phone Number: | 3367223774 |
| Business Fax Number: | |
| Mailing Address: | 5401 Covenant Ln, WINSTON SALEM |
| State: | NC |
| Postal Code: | 271066459 |
| Phone Number: | 3367223774 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2012 |
| NPI Last Update Date: | 10/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 11924 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |