Provider Demographics
NPI:1649291436
Name:GHEGAN, JOANNA C (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:C
Last Name:GHEGAN
Suffix:
Gender:F
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 8159
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-0159
Mailing Address - Country:US
Mailing Address - Phone:251-414-5810
Mailing Address - Fax:251-414-5809
Practice Address - Street 1:1300 HOSPITAL DR STE 310
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3217
Practice Address - Country:US
Practice Address - Phone:843-737-6030
Practice Address - Fax:843-207-2289
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24483208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC244832OtherMEDICAL LISENCE NUMBER