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Individual
MRS. DEANA LEE GROGAN
Active
Individual
MRS. DEANA LEE GROGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA/AA
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
005379
GA
367H00000X
Anesthesiologist Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
554654
WELLCARE
GA
01
—
580628385
TRICARE
GA
05
—
843004781C
—
GA
05
—
843004781D
—
GA
01
—
P00847169
RAILROAD MEDICARE
GA
Enumeration date
07/24/2008
Last updated
06/04/2013
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