Provider Demographics
NPI:1659417319
Name:PUGH, TIMOTHY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:PUGH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3343 PUCKETTS MILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3005
Mailing Address - Country:US
Mailing Address - Phone:770-614-6363
Mailing Address - Fax:770-614-5672
Practice Address - Street 1:3343 PUCKETTS MILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-3005
Practice Address - Country:US
Practice Address - Phone:770-614-6363
Practice Address - Fax:770-614-5672
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHZHMedicare ID - Type Unspecified
GAV03152Medicare UPIN