Provider Demographics
NPI:1346281318
Name:POAG, JOHN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:POAG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E BESSEMER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1416
Mailing Address - Country:US
Mailing Address - Phone:336-574-0074
Mailing Address - Fax:336-379-7466
Practice Address - Street 1:200 E BESSEMER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1416
Practice Address - Country:US
Practice Address - Phone:336-574-0074
Practice Address - Fax:336-379-7466
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6128436OtherUNITED HEALTHCARE
NC03926OtherBLUE CROSS BLUE SHIELD
NC7466109OtherAETNA
NC6000008Medicaid
NC6000008Medicaid