Healthcare Provider Details

I. General information

NPI: 1386902278
Provider Name (Legal Business Name): OSCAR SEGOVIA PNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OSCAR MANUEL SEGOVIA RUIZ

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

PO BOX 422002
ATLANTA GA
30342-9002
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5009
  • Fax: 404-785-9168
Mailing address:
  • Phone: 770-938-0772
  • Fax: 770-621-9230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN185083
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN185083
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: