Provider Demographics
NPI:1346334505
Name:PUGH, MARY JO (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 18TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1724
Mailing Address - Country:US
Mailing Address - Phone:706-322-4950
Mailing Address - Fax:706-322-5614
Practice Address - Street 1:1201 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1724
Practice Address - Country:US
Practice Address - Phone:706-322-4950
Practice Address - Fax:706-322-5614
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118053363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology