Provider Demographics
NPI:1891793253
Name:DUGGAN, ASA DANIEL JR (MD)
Entity Type:Individual
Prefix:
First Name:ASA
Middle Name:DANIEL
Last Name:DUGGAN
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 31258
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-3058
Mailing Address - Country:US
Mailing Address - Phone:706-854-6938
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:2258 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4887
Practice Address - Country:US
Practice Address - Phone:706-481-7899
Practice Address - Fax:706-481-7898
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA020691208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG20691Medicaid
GA000263898CMedicaid
GA000263898CMedicaid