Provider Demographics
NPI:1780626804
Name:LOGAN, JAMES ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5356 REYNOLDS ST
Mailing Address - Street 2:SUITE 505
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6106
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:SUITE 505
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6106
Practice Address - Country:US
Practice Address - Phone:912-644-5300
Practice Address - Fax:912-644-5260
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0100024207Y00000X
GA010024207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000019786KMedicaid
GA202I049602Medicare PIN
GAD70551Medicare UPIN
GA04BDCSXMedicare PIN
D70551Medicare UPIN