Healthcare Provider Details

I. General information

NPI: 1255896635
Provider Name (Legal Business Name): STEVEN M HAGAN PA-C, DMO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD BLDG 9250
FORT BENNING GA
31905-2102
US

IV. Provider business mailing address

6600 VAN AALST BLVD BLDG 9250
FORT BENNING GA
31905-2102
US

V. Phone/Fax

Practice location:
  • Phone: 705-544-2273
  • Fax:
Mailing address:
  • Phone: 910-257-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: