Provider Demographics
NPI:1396753471
Name:FOGG, DARLENE E (MD)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:E
Last Name:FOGG
Suffix:
Gender:F
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:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-530-7900
Mailing Address - Fax:423-530-7901
Practice Address - Street 1:2002 BROOKSIDE DR STE 300
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-530-7900
Practice Address - Fax:423-232-8580
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1396753471Medicaid
TN3863999Medicaid
TNP01015963OtherRR MEDICARE
TN3863999Medicaid
TN103I161566Medicare PIN