Provider Demographics
NPI:1346216249
Name:HAGERMAN, PATRICIA A (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:HAGERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 PROFESSIONAL DR STE 510
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3336
Mailing Address - Country:US
Mailing Address - Phone:770-513-2072
Mailing Address - Fax:770-513-7896
Practice Address - Street 1:1525 RIVERSHYRE PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-6428
Practice Address - Country:US
Practice Address - Phone:770-277-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004006363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I979283OtherMEDICARE ID