Provider Demographics
NPI:1578555876
Name:HOGAN, DANA JUNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:JUNE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 CAPITAL AVE STE 105
Mailing Address - Street 2:P O BOX 1379
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1832
Mailing Address - Country:US
Mailing Address - Phone:706-769-9410
Mailing Address - Fax:706-769-9475
Practice Address - Street 1:1160 CAPITAL AVE STE 105
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1832
Practice Address - Country:US
Practice Address - Phone:706-769-9410
Practice Address - Fax:706-769-9475
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044236208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000755961EMedicaid
GA000755961GMedicaid
GA044236OtherMEDICAL LISCENSE
1578555876OtherINDIVIDUAL NPI
1138488848OtherGROUP NPI
GA582560190OtherTAX ID
GA582560190OtherTAX ID
GA658251501AMedicaid
GA5703737OtherAETNA PIN#