Healthcare Provider Details

I. General information

NPI: 1104817824
Provider Name (Legal Business Name): DONALD W HUFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 DUNLOP LN
CLARKSVILLE TN
37040-5007
US

IV. Provider business mailing address

801 SHADY BLUFF TRL
CLARKSVILLE TN
37043-5928
US

V. Phone/Fax

Practice location:
  • Phone: 931-245-8600
  • Fax: 931-245-8660
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27772
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: