Provider Demographics
NPI:1760559512
Name:HOGUE KINAHAN, JANICE K (NP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:K
Last Name:HOGUE KINAHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1301 SHILOH RD NW
Mailing Address - Street 2:STE 1611
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7147
Mailing Address - Country:US
Mailing Address - Phone:770-804-9479
Mailing Address - Fax:877-795-9149
Practice Address - Street 1:1301 SHILOH RD NW
Practice Address - Street 2:STE 1611
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7147
Practice Address - Country:US
Practice Address - Phone:770-804-9479
Practice Address - Fax:877-795-9149
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN087295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I506758Medicare PIN