Provider Demographics
NPI:1134294846
Name:PUGH, MATTHEW E (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:PUGH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 RACHEL VIEW CT
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-6983
Mailing Address - Country:US
Mailing Address - Phone:706-654-7648
Mailing Address - Fax:
Practice Address - Street 1:33 HILL TOP DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1261
Practice Address - Country:US
Practice Address - Phone:706-387-0390
Practice Address - Fax:706-387-0137
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV11932Medicare UPIN
GA35ZCJWDMedicare PIN