Organization
MJPUGH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIMOND M PUGH (OWNER)
(901) 833-1385
Entity
Organization
Contact information
Practice address
310 BAY GROVE RD, LOGANVILLE, GA 30052-6619
(901) 833-1385
Mailing address
310 BAY GROVE RD, LOGANVILLE, GA 30052-6619
(901) 833-1385
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
08/24/2019
Last updated
08/24/2019
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