MEDICARE: DAVID K GROGAN P.A.

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	363A00000X	Physician Assistant	002483	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	970028283	OTHER	GA	RR MEDICARE

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	:	1841294386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID K GROGAN P.A.

Provider Business Mailing Address
First Line	:	216 CORDER RD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-3604
Country	:	US
Telephone Number	:	478-923-5872
Fax Number	:	478-922-9020

Provider Business Practice Location Address
First Line	:	216 CORDER RD
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088
Country	:	US
Telephone Number	:	478-923-5872
Fax Number	:	478-922-9020

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/13/2018

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Directions to “ DAVID K GROGAN P.A.” Practice Location

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