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General NPI Number Information
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NPI Number | 1013074053
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Entity Type | Organization
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Legal Business Name | PIEDMONT GYN AND OB PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 77 COLLIER RD NW SUITE 2010
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City | ATLANTA
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State | GA
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Zip | 30309-1764
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Country | US
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Telephone | 404-355-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 3025 BRECKINRIDGE BLVD SUITE 120
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City | DULUTH
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State | GA
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Zip | 30096-7611
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Country | US
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Telephone | 678-226-0022
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN B PUGH
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Credential | M.D.
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Telephone | 404-355-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 028628
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License Number State | GA
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