Healthcare Provider Details

I. General information

NPI: 1477757052
Provider Name (Legal Business Name): JUAN ARMANDO PENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD STE 660
ATLANTA GA
30342-1608
US

IV. Provider business mailing address

980 JOHNSON FERRY RD STE 660
SANDY SPRINGS GA
30342-1608
US

V. Phone/Fax

Practice location:
  • Phone: 404-847-1580
  • Fax:
Mailing address:
  • Phone: 404-847-1592
  • Fax: 404-303-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number87091
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number264972
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBP1-0026607
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: