Provider Demographics
NPI:1639262660
Name:HOGAN, MICHAEL GRAHAM (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GRAHAM
Last Name:HOGAN
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 1:107 COLONY PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2763
Mailing Address - Country:US
Mailing Address - Phone:770-456-5817
Mailing Address - Fax:770-573-7203
Practice Address - Street 1:107 COLONY PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2763
Practice Address - Country:US
Practice Address - Phone:770-456-5817
Practice Address - Fax:770-573-7203
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031440174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000390706GMedicaid
GA00390706CMedicaid
GA000390706IMedicaid
GA000390706HMedicaid
GA202I201684Medicare PIN
GA00390706CMedicaid
GA000390706HMedicaid
GA000390706GMedicaid