Provider Demographics
NPI:1386902278
Name:SEGOVIA, OSCAR (PNP)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:SEGOVIA
Suffix:
Gender:M
Credentials:PNP
Other - Prefix:
Other - First Name:OSCAR
Other - Middle Name:MANUEL
Other - Last Name:SEGOVIA RUIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 422002
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-9002
Mailing Address - Country:US
Mailing Address - Phone:770-938-0772
Mailing Address - Fax:770-621-9230
Practice Address - Street 1:1001 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1605
Practice Address - Country:US
Practice Address - Phone:404-785-5009
Practice Address - Fax:404-785-9168
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN185083163WE0003X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WE0003XNursing Service ProvidersRegistered NurseEmergency