Provider Demographics
NPI:1679336689
Name:PUGH, STEVEN L (RN)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:PUGH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3397 MISTY HARBOUR TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4229
Mailing Address - Country:US
Mailing Address - Phone:305-610-8695
Mailing Address - Fax:
Practice Address - Street 1:2531 BRIARCLIFF RD NE STE 119
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3017
Practice Address - Country:US
Practice Address - Phone:305-610-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9281253163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery