=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033922778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANN PUGH RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2025
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 EAST HOSPITAL DRIVE PULMONARY DEPARTMENT
-----------------------------------------------------
City | FORT EISENHOWER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30905-5650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-787-2868
-----------------------------------------------------
Fax | 706-787-3059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1468 KNOB HILL CIR
-----------------------------------------------------
City | EVANS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30809-6678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-865-7221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | 041287632
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------