# BENNETT P HOGAN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134184864
- **Authorized official:** BENNETT PATE HOGAN M.D. (PRESIDENT)
- **Authorized official phone:** (229) 333-0616

## Contact information

- **Practice address:** 117 W NORTHSIDE DR, VALDOSTA, GA 31602-1700
- **Practice address phone:** (229) 333-0616
- **Practice address fax:** (229) 333-0647
- **Mailing address:** 117 W NORTHSIDE DR, VALDOSTA, GA 31602-1754
- **Mailing address phone:** (229) 333-0616
- **Mailing address fax:** (229) 333-0647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 050024 | GA | Yes |

## Other

- **Enumeration date:** 04/18/2006
- **Last updated:** 03/19/2013