Healthcare Provider Details

I. General information

NPI: 1942258314
Provider Name (Legal Business Name): ANDREW PUGLIESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 LAUREL SPRINGS PKWY STE 1404
SUWANEE GA
30024-6098
US

IV. Provider business mailing address

5400 LAUREL SPRINGS PKWY STE 1404
SUWANEE GA
30024-6098
US

V. Phone/Fax

Practice location:
  • Phone: 678-347-2153
  • Fax: 678-473-9752
Mailing address:
  • Phone: 678-347-2153
  • Fax: 678-990-1387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number041643
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: