MEDICARE: MS. MARY JO PUGH NP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	RN118053	GA

General Provider Information

NPI Number	:	1346334505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY JO PUGH NP

Provider Business Mailing Address
First Line	:	1201 18TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1724
Country	:	US
Telephone Number	:	706-322-4950
Fax Number	:	706-322-5614

Provider Business Practice Location Address
First Line	:	1201 18TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1724
Country	:	US
Telephone Number	:	706-322-4950
Fax Number	:	706-322-5614

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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