MEDICARE: DR. JUAN ARMANDO PENA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	87091	GA
2	207R00000X	Internal Medicine Physician	264972	NY
3	207V00000X	Obstetrics & Gynecology Physician	BP1-0026607	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3860119111	OTHER		MYUTMB 3860119111-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1477757052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN ARMANDO PENA MD

Provider Business Mailing Address
First Line	:	980 JOHNSON FERRY RD STE 660
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-1608
Country	:	US
Telephone Number	:	404-847-1592
Fax Number	:	404-303-2015

Provider Business Practice Location Address
First Line	:	980 JOHNSON FERRY RD STE 660
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1608
Country	:	US
Telephone Number	:	404-847-1580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	08/25/2021

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