MEDICARE: MRS. EMMA DASHER HAGAN M.ED., APC

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	101YP2500X	Professional Counselor	APC009462	GA

General Provider Information

NPI Number	:	1659134658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMMA DASHER HAGAN M.ED., APC

Provider Business Mailing Address
First Line	:	3623 LOVES CHAPEL RD
Second Line	:
City	:	GLENNVILLE
State	:	GA
Zip	:	30427-6401
Country	:	US
Telephone Number	:	912-237-5902
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 MYRTLE CROSSING DR
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-4688
Country	:	US
Telephone Number	:	912-764-7001
Fax Number	:

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

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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