Healthcare Provider Details

I. General information

NPI: 1396997037
Provider Name (Legal Business Name): ANDREA K HUFFMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA J KEELER PA

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1764
US

IV. Provider business mailing address

5665 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1764
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1900
  • Fax: 678-843-6849
Mailing address:
  • Phone: 404-778-1900
  • Fax: 678-843-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005468
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: