Individual
LOGAN E HYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
555 JUSTIS DR, GREENEVILLE, TN 37745-4288
(423) 254-6460
(833) 908-2070
Mailing address
PO BOX 26194, BELFAST, ME 04915-2012
(865) 584-4747
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3711
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700C810580
BLUE CROSS OF MI
MI
Enumeration date
07/05/2005
Last updated
06/07/2023
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