Provider Demographics
NPI:1134288848
Name:SUNSHINE PEDIATRICS PC
Entity Type:Organization
Organization Name:SUNSHINE PEDIATRICS PC
Other - Org Name:DANA J HOGAN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:NOVA
Authorized Official - Last Name:QUINN-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-769-9410
Mailing Address - Street 1:1160 CAPITAL AVE STE 105
Mailing Address - Street 2:P O BOX 1379
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1832
Mailing Address - Country:US
Mailing Address - Phone:706-769-9410
Mailing Address - Fax:706-769-9475
Practice Address - Street 1:1160 CAPITAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1832
Practice Address - Country:US
Practice Address - Phone:706-769-9410
Practice Address - Fax:706-769-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044236208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA106027OtherPEACHSTATE PROVIDER NUMBER
GA0005703737OtherAETNA PIN #
GA044236OtherGEORGIA MEDICAL LIC NUMBE
GA526365270003OtherBCBS PROVIDER ID
GA1578555876OtherDANA J HOGAN MD NPI
GA10033203OtherAMERIGROUP COMM CARE PROV
GA000096226OtherGHP PROVIDER REF#
GA000755961EMedicaid
GA658251501AMedicaid
GA658251501AMedicaid