Provider Demographics
NPI:1881152155
Name:DEEGAN, JOAN ELIZABETH (PCA)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ELIZABETH
Last Name:DEEGAN
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 REDMOND CIR NW STE D
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1379
Mailing Address - Country:US
Mailing Address - Phone:706-784-4533
Mailing Address - Fax:707-784-4982
Practice Address - Street 1:1838 REDMOND CIR NW STE D
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1379
Practice Address - Country:US
Practice Address - Phone:706-784-4533
Practice Address - Fax:706-784-4982
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057R1934376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide