Provider Demographics
NPI:1831716265
Name:POUGH, JOSEPH WAYNE (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WAYNE
Last Name:POUGH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 MOFFETT RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-4413
Mailing Address - Country:US
Mailing Address - Phone:251-234-9303
Mailing Address - Fax:
Practice Address - Street 1:6711 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-4413
Practice Address - Country:US
Practice Address - Phone:251-645-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant