Healthcare Provider Details

I. General information

NPI: 1174044812
Provider Name (Legal Business Name): ANTHONY GRAVES HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 HIGHWAY 51 S
COVINGTON TN
38019-3630
US

IV. Provider business mailing address

8360 HIGHWAY 59 W
BURLISON TN
38015-7483
US

V. Phone/Fax

Practice location:
  • Phone: 901-476-8967
  • Fax: 907-476-2498
Mailing address:
  • Phone: 901-356-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: