MEDICARE: EDWARD HOGGARD JR.

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	1041C0700X	Clinical Social Worker	12617-C	NV
2	1041C0700X	Clinical Social Worker	0904014820	VA

General Provider Information

NPI Number	:	1790215390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD HOGGARD JR.

Provider Business Mailing Address
First Line	:	2013 BALLSTON PL
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7439
Country	:	US
Telephone Number	:	919-302-3274
Fax Number	:

Provider Business Practice Location Address
First Line	:	6295 HARRISON DR STE 4
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-4057
Country	:	US
Telephone Number	:	919-302-3274
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	03/26/2026

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Directions to “ EDWARD HOGGARD JR. ” Practice Location

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