Healthcare Provider Details

I. General information

NPI: 1134584709
Provider Name (Legal Business Name): CASSANDRA DENISE HUGHLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 FIELD SPRING DR
LITHONIA GA
30058-3851
US

IV. Provider business mailing address

2860 FIELD SPRING DR
LITHONIA GA
30058-3851
US

V. Phone/Fax

Practice location:
  • Phone: 678-387-8076
  • Fax:
Mailing address:
  • Phone: 678-387-8076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberCN0028837596
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: