Individual
KAMI BONNER PUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3720 DAVINCI CT, SUITE 400, NORCROSS, GA 30092-7627
(770) 300-3555
Mailing address
3720 DAVINCI CT, SUITE 400, NORCROSS, GA 30092-7627
(770) 300-3555
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN138402
GA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN138402
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NCO-000001
NCO AMERICAN ACADEMY OF NURSE PRACTITIONERS
GA
01
—
RN138402
ADVANCED PRACTICE -- NP LICENSE
GA
Enumeration date
03/26/2014
Last updated
07/28/2015
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