Provider Demographics
NPI:1518316207
Name:MRUGALA, ANDREW STEFAN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEFAN
Last Name:MRUGALA
Suffix:
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 1:101 ST. JOSEPH'S CANDLER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322
Mailing Address - Country:US
Mailing Address - Phone:912-748-1999
Mailing Address - Fax:912-748-3847
Practice Address - Street 1:101 SAINT JOSEPHS CANDLER DR STE 200
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9585
Practice Address - Country:US
Practice Address - Phone:912-748-1999
Practice Address - Fax:912-748-3847
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-01744207Q00000X, 208M00000X
GA86158207RG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003235519AMedicaid
IN11018773AOtherSTATE LICENSE