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General NPI Number Information
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NPI Number | 1578555876
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Entity Type | Individual
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Provider Name | DANA JUNE HOGAN MD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1160 CAPITAL AVE STE 105
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City | WATKINSVILLE
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State | GA
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Zip | 30677-1832
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Country | US
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Telephone | 706-769-9410
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Fax | 706-769-9475
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Provider Business Mailing Address
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Address Line | 1160 CAPITAL AVE STE 105 P O BOX 1379
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City | WATKINSVILLE
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State | GA
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Zip | 30677-1832
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Country | US
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Telephone | 706-769-9410
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Fax | 706-769-9475
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 044236
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License Number State | GA
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