MEDICARE: KENNETH OGAN M.D.

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
1	208800000X	Urology Physician	51699	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477584423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH OGAN M.D.

Provider Business Mailing Address
First Line	:	8205 TROLLEY SQUARE XING NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3775
Country	:	US
Telephone Number	:	404-274-2036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365B CLIFTON RD NE
Second Line	:	SUITE B1400
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-4898
Fax Number	:	404-778-4006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	06/17/2026

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