MEDICARE: MS. TEMEKA TAYLOR BUGGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN171085	GA

General Provider Information

NPI Number	:	1154817799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TEMEKA TAYLOR BUGGS

Provider Business Mailing Address
First Line	:	118 FLOWERS DR
Second Line	:
City	:	BLAKELY
State	:	GA
Zip	:	39823-2810
Country	:	US
Telephone Number	:	229-309-2605
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 WASHINGTON ST S
Second Line	:
City	:	FORT GAINES
State	:	GA
Zip	:	39851-4315
Country	:	US
Telephone Number	:	229-768-3888
Fax Number	:	229-768-3889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2018
Last Update Date	:	07/06/2018

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