Provider Demographics
NPI:1477650414
Name:HAGAN, WILLIAM R JR (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:HAGAN
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PEACHTREE ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3505
Mailing Address - Country:US
Mailing Address - Phone:828-274-3477
Mailing Address - Fax:828-274-7407
Practice Address - Street 1:76 PEACHTREE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3505
Practice Address - Country:US
Practice Address - Phone:828-274-3477
Practice Address - Fax:828-274-7407
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114654367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8000315Medicaid
NC260557OtherMEDICARE PTAN
NC235113EOtherMEDICARE PTAN
NC430043596OtherSWAIN RR MCARE
NC114654OtherLICENSE NUMBER
NC8000180Medicaid
NC2625250OtherPROVIDER NO CIGNA
NC4300035342OtherHARRIS RR MCARE
NC4300035342OtherHARRIS RR MCARE
NC2625250OtherPROVIDER NO CIGNA