Provider Demographics
NPI:1659426997
Name:JOE DILLARD NOGGLE JR MD PC
Entity Type:Organization
Organization Name:JOE DILLARD NOGGLE JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:D
Authorized Official - Last Name:NOGGLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-754-5036
Mailing Address - Street 1:481 441 HISTORIC HWY N
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-4527
Mailing Address - Country:US
Mailing Address - Phone:706-754-5036
Mailing Address - Fax:706-754-5037
Practice Address - Street 1:481 441 HISTORIC HWY N
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4527
Practice Address - Country:US
Practice Address - Phone:706-754-5036
Practice Address - Fax:706-754-5037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA260925194AMedicare ID - Type Unspecified