Pendarvis, Derek Paul
Pendarvis, Derek Paul is an individual health care provider with primary practice located at 725 Jesse Jewell Pkwy Se , Gainesville GA 30501-3834. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Pendarvis, Derek Paul can be contacted via phone (770) 536-2323.Contact Information
Primary practice address
725 Jesse Jewell Pkwy Se
Gainesville GA 30501-3834
Phone: (770) 536-2323
Fax: (770) 536-4947
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 049933 | Georgia |
Profile Details
| NPI number | 1104806108 |
|---|---|
| LBN Legal business name | Pendarvis, Derek Paul |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 18th, 2006 |
| Last updated | May 22nd, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104806108 | NPPES |
| Georgia | Other | 1700231 | UNITED HEALTHCARE |
| Georgia | MEDICAID | 000904274A | UNITED HEALTHCARE |
| Georgia | Other | 10045029 | UNITED HEALTHCARE |
| Georgia | Other | 52843776 | UNITED HEALTHCARE |
| Georgia | MEDICAID | 000904274B | UNITED HEALTHCARE |
| Georgia | Other | 341106 | UNITED HEALTHCARE |
| Georgia | Other | 7816063 | UNITED HEALTHCARE |
| Georgia | Other | 20050660 | UNITED HEALTHCARE |
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