Provider Demographics
NPI:1609962356
Name:SCRUGGS, JANNET R (MD)
Entity Type:Individual
Prefix:
First Name:JANNET
Middle Name:R
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANNET
Other - Middle Name:R
Other - Last Name:AJALA, AJALA-SCRUGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:678-475-0980
Practice Address - Street 1:750 TOWNPARK LANE
Practice Address - Street 2:KAISER PERMANENTE TOWNPARK MEDICAL OFFICE
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:770-514-5401
Practice Address - Fax:478-454-3969
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049433207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000890623CMedicaid
GA000890623CMedicaid
GA93BFBPHMedicare ID - Type Unspecified