Provider Demographics
NPI:1902433246
Name:MAYUGA, TOM JOHN ALBUNIAN (DO)
Entity Type:Individual
Prefix:
First Name:TOM JOHN
Middle Name:ALBUNIAN
Last Name:MAYUGA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:236 STOCKBRIDGE RD STE B-2
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3629
Mailing Address - Country:US
Mailing Address - Phone:770-742-9326
Mailing Address - Fax:862-298-0871
Practice Address - Street 1:236 STOCKBRIDGE RD STE B-2
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3629
Practice Address - Country:US
Practice Address - Phone:770-742-9326
Practice Address - Fax:862-298-0871
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93028207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine