Provider Demographics
NPI:1902000227
Name:JAMES LOWELL HAGAN,SR, M.D., LLC.
Entity Type:Organization
Organization Name:JAMES LOWELL HAGAN,SR, M.D., LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-233-6576
Mailing Address - Street 1:100 AURORA PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6356
Mailing Address - Country:US
Mailing Address - Phone:803-233-6576
Mailing Address - Fax:803-233-4675
Practice Address - Street 1:100 AURORA PL
Practice Address - Street 2:SUITE 200
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6356
Practice Address - Country:US
Practice Address - Phone:803-649-6380
Practice Address - Fax:803-649-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12240208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2292Medicaid
SC8754Medicare PIN