Provider Demographics
NPI:1215034483
Name:BUGGS, THEODIS JR (MD)
Entity Type:Individual
Prefix:MR
First Name:THEODIS
Middle Name:
Last Name:BUGGS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:205-783-7832
Practice Address - Street 1:750 TOWNPARK LN NW
Practice Address - Street 2:KAISER PERMANENTE TOWNPARK MEDICAL CENTER
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5579
Practice Address - Country:US
Practice Address - Phone:205-783-7830
Practice Address - Fax:205-783-7832
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00009766207X00000X
GA028947207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521019OtherBLUE CROSS BLUE SHIELD OF
AL051521019Medicaid
AL51521019OtherBLUE CROSS BLUE SHIELD OF
AL051521019Medicare ID - Type Unspecified