Individual
BENNETT P HOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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 31602-1700
(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
04/20/2006
Last updated
06/27/2012
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