Healthcare Provider Details

I. General information

NPI: 1417005943
Provider Name (Legal Business Name): CALVIN WILLIS HUFF D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3059 LAWRENCEVILLE HWY STE. D
LAWRENCEVILLE GA
30044-6426
US

IV. Provider business mailing address

427 GOLDEN DELICIOUS RD
CLARKESVILLE GA
30523-1386
US

V. Phone/Fax

Practice location:
  • Phone: 770-931-9996
  • Fax: 706-839-1634
Mailing address:
  • Phone: 706-839-1636
  • Fax: 706-839-1634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN008991
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: