Provider Demographics
NPI:1063652212
Name:FOGG, RYAN NOELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NOELLE
Last Name:FOGG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1240 JESSE JEWELL PKWY SE
Mailing Address - Street 2:STE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3862
Mailing Address - Country:US
Mailing Address - Phone:770-532-8438
Mailing Address - Fax:770-535-1785
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE
Practice Address - Street 2:STE 200
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3862
Practice Address - Country:US
Practice Address - Phone:770-532-8438
Practice Address - Fax:770-535-1785
Is Sole Proprietor?:No
Enumeration Date:2009-03-01
Last Update Date:2018-01-10
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Provider Licenses
StateLicense IDTaxonomies
GAMD060715208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology