Basic Information
| Provider Information | |||||||||
| NPI: | 1891749982 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOERNER | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 116171 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303686171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009191190 | ||||||||
| FaxNumber: | 7067372272 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 HOSPITAL BLVD | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300764915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707512623 | ||||||||
| FaxNumber: | 7707512609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 02/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 056461 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 056461 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | G56461 | 01 | SC | SC MEDICAID | OTHER |