| Doctor Name: | JOHN PENUEL |
| NPI Number: | 1285633842 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 9900983 |
| Business Practice Address: | 821 N Cobb St Milledgeville, GA - 310612343 |
| Business Phone Number: | 4784520524 |
| Business Fax Number: | 4784520525 |
| Mailing Address: | 1854 Shackleford Ct, Suite 350 NORCROSS |
| State: | GA |
| Postal Code: | 300932954 |
| Phone Number: | 7706883801 |
| Fax Number: | 7702376148 |
| NPI Enumeration Date: | 07/18/2005 |
| NPI Last Update Date: | 04/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 9900983 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |