Healthcare Provider Details

I. General information

NPI: 1366305831
Provider Name (Legal Business Name): MRS. NICOLE HUFFINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ARLINGTON PL
MACON GA
31201-1704
US

IV. Provider business mailing address

105 DELAWARE AVE
WARNER ROBINS GA
31093-2379
US

V. Phone/Fax

Practice location:
  • Phone: 478-718-7280
  • Fax:
Mailing address:
  • Phone: 478-722-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: