Provider Demographics
NPI:1477970549
Name:PUGH, KAMI BONNER (NP-C)
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:BONNER
Last Name:PUGH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KAMI
Other - Middle Name:BONNER
Other - Last Name:PUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3720 DAVINCI CT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-7627
Mailing Address - Country:US
Mailing Address - Phone:770-300-3555
Mailing Address - Fax:
Practice Address - Street 1:3720 DAVINCI CT
Practice Address - Street 2:SUITE 400
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7627
Practice Address - Country:US
Practice Address - Phone:770-300-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138402363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANCO-000001OtherNCO AMERICAN ACADEMY OF NURSE PRACTITIONERS
GARN138402OtherADVANCED PRACTICE -- NP LICENSE