Provider Demographics
NPI:1952034340
Name:HOGUE, MADISON S (FNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:S
Last Name:HOGUE
Suffix:
Gender:F
Credentials:FNP-BC, FNP-C
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:ALEXIS
Other - Last Name:SAXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:464 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:LULA
Mailing Address - State:GA
Mailing Address - Zip Code:30554-3348
Mailing Address - Country:US
Mailing Address - Phone:770-533-2770
Mailing Address - Fax:
Practice Address - Street 1:4300 WESTBROOK RD BLDG A
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4987
Practice Address - Country:US
Practice Address - Phone:678-821-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCO-000003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily