Basic Information
Provider Information
NPI: 1811942535
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEGARTY
FirstName: JOSEPH
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 210 E DERENNE AVE
Address2:  
City: SAVANNAH
State: GA
PostalCode: 31405
CountryCode: US
TelephoneNumber: 9126445300
FaxNumber: 9126445260
Practice Location
Address1: 210 E DERENNE AVENUE
Address2:  
City: SAVANNAH
State: GA
PostalCode: 31405
CountryCode: US
TelephoneNumber: 9126445300
FaxNumber: 9126445260
Other Information
ProviderEnumerationDate: 05/23/2006
LastUpdateDate: 02/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X049900GAY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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