Individual
BRANDI LAWANE PUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5451 BOWMAN RD STE 240, MACON, GA 31210-5787
(478) 259-0889
Mailing address
122 SILVER LAKE CT, MACON, GA 31211-7032
(478) 731-9387
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHRI011113
GA
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/08/2019
Last updated
01/26/2024
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