Provider Demographics
NPI:1558335802
Name:SKAGGS, HAROLD L JR (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:L
Last Name:SKAGGS
Suffix:JR
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 2968
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30156-9117
Mailing Address - Country:US
Mailing Address - Phone:770-779-0015
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-851-6936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034472207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000474889EMedicaid
GA10043505OtherAMERIGROUP
GA096002OtherBCBS OF GEORGIA
GA000474889Medicaid
GA000474889FMedicaid
GA3333413OtherWELLCARE OF GEORGIA
GA096425OtherBCBS OF GEORGIA
GA10649OtherKAISER
GAE97144Medicare UPIN
GA000474889EMedicaid
GA93BDWHHMedicare ID - Type Unspecified
GAP00080089Medicare PIN