Provider Demographics
NPI:1629536545
Name:PUGH, AARON NICHOLAS
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:NICHOLAS
Last Name:PUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 DUNDEE PASS
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-3818
Mailing Address - Country:US
Mailing Address - Phone:478-397-7246
Mailing Address - Fax:
Practice Address - Street 1:117 DUNDEE PASS
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-3818
Practice Address - Country:US
Practice Address - Phone:478-397-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2019-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003753225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty