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NPI Code Detail

MEDICARE: LOGAN E HYATT PA

MEDICARE: LOGAN E HYATT PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant3711TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1700C810580OTHERMIBLUE CROSS OF MI

General Provider Information

NPI Number : 1114924222
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOGAN E HYATT PA
Provider Business Mailing Address
First Line : PO BOX 26194
Second Line :
City : BELFAST
State : ME
Zip : 04915-2012
Country : US
Telephone Number : 865-584-4747
Fax Number :
Provider Business Practice Location Address
First Line : 555 JUSTIS DR
Second Line :
City : GREENEVILLE
State : TN
Zip : 37745-4288
Country : US
Telephone Number : 423-254-6460
Fax Number : 833-908-2070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 06/07/2023

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Directions to “ LOGAN E HYATT PA” Practice Location

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