1578555876 NPI number — DR. DANA JUNE HOGAN MD

Table of content: DR. DANA JUNE HOGAN MD (NPI 1578555876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578555876 NPI number — DR. DANA JUNE HOGAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOGAN
Provider First Name:
DANA
Provider Middle Name:
JUNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578555876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 HOG MOUNTAIN ROAD BLDG 200 SUITE 101
Provider Second Line Business Mailing Address:
P O BOX 1379
Provider Business Mailing Address City Name:
WATKINSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30677-1832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-769-9410
Provider Business Mailing Address Fax Number:
706-769-9475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 HOG MOUNTAIN RD BLDG 200 STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATKINSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30677-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-769-9410
Provider Business Practice Location Address Fax Number:
706-769-9475
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  044236 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000755961E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 044236 . This is a "MEDICAL LISCENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1578555876 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000755961H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1138488848 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 582560190 . This is a "TAX ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000755961G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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