Provider Demographics
NPI:1871625020
Name:BUGG, KIMARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:KIMARIE
Middle Name:
Last Name:BUGG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 HOSEA WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1902
Mailing Address - Country:US
Mailing Address - Phone:404-373-3530
Mailing Address - Fax:404-373-5036
Practice Address - Street 1:1550 HOSEA WILLIAMS DRIVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1902
Practice Address - Country:US
Practice Address - Phone:404-373-3530
Practice Address - Fax:404-373-5036
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN58415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily