Basic Information
Provider Information
NPI: 1285696393
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SNUGGS
FirstName: BARBORA
MiddleName: CERNY
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1825 MARTHA BERRY BLVD NW
Address2:  
City: ROME
State: GA
PostalCode: 301651625
CountryCode: US
TelephoneNumber: 7062955331
FaxNumber:  
Practice Location
Address1: 150 GENTILLY BLVD
Address2:  
City: CARTERSVILLE
State: GA
PostalCode: 301208522
CountryCode: US
TelephoneNumber: 7703825611
FaxNumber: 7703828381
Other Information
ProviderEnumerationDate: 04/04/2006
LastUpdateDate: 09/23/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XRN124381GAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

ID Information
IDTypeStateIssuerDescription
980829861B05GA MEDICAID
980829861D05GA MEDICAID
980829861C05GA MEDICAID


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