Provider Demographics
NPI:1316939499
Name:PUGH, JOHN BARR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BARR
Last Name:PUGH
Suffix:
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 1:2001 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 435
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1476
Mailing Address - Country:US
Mailing Address - Phone:404-355-6600
Mailing Address - Fax:404-352-0657
Practice Address - Street 1:2001 PEACHTREE RD NE
Practice Address - Street 2:SUITE 435
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1476
Practice Address - Country:US
Practice Address - Phone:404-355-6600
Practice Address - Fax:404-352-0657
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28628207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP543Medicare ID - Type UnspecifiedPROVIDER NUMBER
GAD40912Medicare UPIN