Individual
DR. JUAN ANTONIO MUJICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 VILLAGE CENTER PKWY, STOCKBRIDGE, GA 30281-9044
(770) 474-5952
(770) 474-1300
Mailing address
210 VILLAGE CENTER PKWY, STOCKBRIDGE, GA 30281-9044
(770) 474-5952
(770) 474-1300
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
023193
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
580685000
TRICARE
GA
01
—
591423
BLUE CROSS BLUE SHIELD GA
GA
01
—
D30300
COVENTRY
GA
Enumeration date
06/21/2005
Last updated
01/06/2010
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