MEDICARE: DR. BRANDON POGUE D.V.M.

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	174M00000X	Veterinarian	VET007859	GA

General Provider Information

NPI Number	:	1922404102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON POGUE D.V.M.

Provider Business Mailing Address
First Line	:	455 ABERNATHY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-2505
Country	:	US
Telephone Number	:	404-459-0903
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 ABERNATHY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-2505
Country	:	US
Telephone Number	:	404-459-0903
Fax Number	:

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

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	11/14/2014

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