Active NPI
Marc Anthony Pupo, RN
- Emergency Registered Nurse
- Decatur, GA
National Provider Identifier
1629007596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Registered Nurse
- License
- RN107131
- Practice address
- 1670 Clairmont Rd
Decatur, GA 30033-4004 - Phone
- (404) 321-6111
- NPI assigned
- Jul 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN107131 | GA | |
| Emergency Registered Nurse | 163WE0003X | RN107131 | GA | Primary |
| Ambulatory Care Registered Nurse | 163WP2201X | RN107131 | GA |
Addresses
Primary practice location
1670 Clairmont Rd
Decatur, GA 30033-4004
Mailing address
PO Box 2086
Loganville, GA 30052-1918
Phone (301) 744-8553
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 81438 | Other | SC | REGISTRATION NUMBER |
| RN127602 | Other | CO | REGISTRATION NUMBER |
| 666998 | Other | CA | REGISTRATION NUMBER |
| RN9219847 | Other | FL | REGISTRATION NUMBER |
| RN109560 | Other | AZ | REGISTRATION NUMBER |
| 4704237121 | Other | MI | REGISTRATION NUMBER |
| RN107131 | Other | GA | REGISTRATION NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN107131 | GA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285027200000",
"number": "1629007596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2086",
"city": "LOGANVILLE",
"state": "GA",
"postal_code": "300521918",
"telephone_number": "301-744-8553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1670 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300334004",
"telephone_number": "404-321-6111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUPO",
"first_name": "MARC",
"middle_name": "ANTHONY",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-02",
"last_updated": "2010-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "GA",
"license": "RN107131",
"primary": false
},
{
"code": "163WE0003X",
"taxonomy_group": "",
"desc": "Registered Nurse, Emergency",
"state": "GA",
"license": "RN107131",
"primary": true
},
{
"code": "163WP2201X",
"taxonomy_group": "",
"desc": "Registered Nurse, Ambulatory Care",
"state": "GA",
"license": "RN107131",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTRATION NUMBER",
"identifier": "81438",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTRATION NUMBER",
"identifier": "RN127602",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTRATION NUMBER",
"identifier": "666998",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTRATION NUMBER",
"identifier": "RN9219847",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTRATION NUMBER",
"identifier": "RN109560",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTRATION NUMBER",
"identifier": "4704237121",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTRATION NUMBER",
"identifier": "RN107131",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.