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Organization

BENNETT P HOGAN MD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BENNETT PATE HOGAN M.D. (PRESIDENT)
(229) 333-0616
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
050024
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000906177A
GA
Enumeration date
04/18/2006
Last updated
03/19/2013
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