Provider Demographics
NPI:1316807795
Name:HOGAN, ANGELA JUNE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JUNE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-5039
Mailing Address - Country:US
Mailing Address - Phone:864-710-8771
Mailing Address - Fax:
Practice Address - Street 1:227 FLAT ROCK RD
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-5039
Practice Address - Country:US
Practice Address - Phone:864-710-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC160059156F00000X, 208600000X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC160059OtherNBSTSA