Healthcare Provider Details

I. General information

NPI: 1891329520
Provider Name (Legal Business Name): ANDREW TODD RUGG MS, NCC, APC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 NORTHRIDGE RD STE 310
ATLANTA GA
30350-6101
US

IV. Provider business mailing address

365 NORTHRIDGE RD STE 310
ATLANTA GA
30350-6101
US

V. Phone/Fax

Practice location:
  • Phone: 770-771-6900
  • Fax:
Mailing address:
  • Phone: 770-771-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC007365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: