Individual
MARC ANTHONY PUPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
Mailing address
PO BOX 2086, LOGANVILLE, GA 30052-1918
(301) 744-8553
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN107131
GA
163WE0003X
Emergency Registered Nurse
Primary
RN107131
GA
163WP2201X
Ambulatory Care Registered Nurse
RN107131
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704237121
REGISTRATION NUMBER
MI
01
—
666998
REGISTRATION NUMBER
CA
01
—
81438
REGISTRATION NUMBER
SC
01
—
RN107131
REGISTRATION NUMBER
GA
01
—
RN109560
REGISTRATION NUMBER
AZ
01
—
RN127602
REGISTRATION NUMBER
CO
01
—
RN9219847
REGISTRATION NUMBER
FL
Enumeration date
07/02/2006
Last updated
09/21/2010
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