Healthcare Provider Details

I. General information

NPI: 1083664270
Provider Name (Legal Business Name): KIMBERLY A HUFFMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 CHURCH ST NE SUITE 300
MARIETTA GA
30060-1122
US

IV. Provider business mailing address

699 CHURCH ST NE SUITE 300
MARIETTA GA
30060-1122
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-8700
  • Fax: 770-425-7601
Mailing address:
  • Phone: 770-422-8700
  • Fax: 770-425-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number45247
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: