Provider Demographics
NPI:1124079835
Name:HAGINS, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:HAGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CHESTNUT ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-1805
Mailing Address - Country:US
Mailing Address - Phone:706-213-1688
Mailing Address - Fax:706-213-1690
Practice Address - Street 1:41 CHESTNUT ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1805
Practice Address - Country:US
Practice Address - Phone:706-213-1688
Practice Address - Fax:706-213-1690
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2277550AMedicare ID - Type Unspecified
GAC84253Medicare UPIN