Individual
PATRICK F. MONGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-4588
(706) 721-7264
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2602
(706) 828-6410
(706) 722-5187
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
022021
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000215982A
—
GA
01
—
000467519A
GRP1619 MEDICAID FQHC
GA
01
—
000471809C
GRP1619 MEDICAID FQHC
GA
05
—
182166
—
SC
01
—
341629
WELLCARE GROUP
GA
01
—
641630
WELLCARE GROUP
GA
01
—
GRP1619
MEDICARE FFS
GA
Enumeration date
08/30/2006
Last updated
08/30/2008
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