Healthcare Provider Details

I. General information

NPI: 1992418073
Provider Name (Legal Business Name): TRACEY HUFFMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 FRANKLIN RD STE A
NEWNAN GA
30263-1312
US

IV. Provider business mailing address

110 FIELD ST APT C118
NEWNAN GA
30263-2080
US

V. Phone/Fax

Practice location:
  • Phone: 404-654-3413
  • Fax:
Mailing address:
  • Phone: 540-798-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010776
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: