Provider Demographics
NPI:1295924868
Name:HOGAN, PAULA EVANS (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:EVANS
Last Name:HOGAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 NEWNAN RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-6428
Mailing Address - Country:US
Mailing Address - Phone:770-836-6667
Mailing Address - Fax:770-836-6722
Practice Address - Street 1:1004 NEWNAN RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-6428
Practice Address - Country:US
Practice Address - Phone:770-836-6667
Practice Address - Fax:770-836-6722
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002591133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered