Provider Demographics
NPI:1164527263
Name:HOGAN, WILLIAM MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MITCHELL
Last Name:HOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31649
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-1649
Mailing Address - Country:US
Mailing Address - Phone:865-539-4000
Mailing Address - Fax:865-539-8215
Practice Address - Street 1:1432 HICKEY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2017
Practice Address - Country:US
Practice Address - Phone:865-539-4000
Practice Address - Fax:865-539-8215
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000142212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0021709OtherBCBST PROVIDER NUMBER
TN103970OtherVALUE OPTIONS PROVIDER ID
TN3197893Medicaid
TN103970OtherVALUE OPTIONS PROVIDER ID
TNB04769Medicare UPIN