Provider Demographics
NPI:1235127135
Name:LOGAN, JANET KAY (CPNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:KAY
Last Name:LOGAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 HENSON RD
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-9628
Mailing Address - Country:US
Mailing Address - Phone:478-955-8832
Mailing Address - Fax:
Practice Address - Street 1:803 MLK DRIVE
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-2227
Practice Address - Country:US
Practice Address - Phone:478-827-0710
Practice Address - Fax:478-827-0677
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN189571 NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics