Healthcare Provider Details

I. General information

NPI: 1922404102
Provider Name (Legal Business Name): BRANDON POGUE D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 ABERNATHY RD
ATLANTA GA
30328-2505
US

IV. Provider business mailing address

455 ABERNATHY RD
ATLANTA GA
30328-2505
US

V. Phone/Fax

Practice location:
  • Phone: 404-459-0903
  • Fax:
Mailing address:
  • Phone: 404-459-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVET007859
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: