Provider Demographics
NPI:1437230612
Name:HOGUE, CAISSON TIMBER (MD)
Entity Type:Individual
Prefix:DR
First Name:CAISSON
Middle Name:TIMBER
Last Name:HOGUE
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 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:809 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6605
Practice Address - Country:US
Practice Address - Phone:843-871-9440
Practice Address - Fax:843-871-5932
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC280751Medicaid
SCGP2858OtherMEDICAID GROUP
SCGP4892OtherMEDICAID GROUP
SCSC18847126Medicare PIN
SCAA27256834Medicare PIN
SC280751Medicaid
SCSC18845281Medicare PIN