Healthcare Provider Details

I. General information

NPI: 1154817799
Provider Name (Legal Business Name): MS. TEMEKA TAYLOR BUGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WASHINGTON ST S
FORT GAINES GA
39851-4315
US

IV. Provider business mailing address

118 FLOWERS DR
BLAKELY GA
39823-2810
US

V. Phone/Fax

Practice location:
  • Phone: 229-768-3888
  • Fax: 229-768-3889
Mailing address:
  • Phone: 229-309-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN171085
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: