Healthcare Provider Details

I. General information

NPI: 1679656987
Provider Name (Legal Business Name): DR. RANDY FORD HUFFINES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JAMES H. QUILLEN/VAMC CORNER OF SIDNEY AND LAMONT
JOHNSON CITY TN
37684
US

IV. Provider business mailing address

516 LONGVIEW DR
JOHNSON CITY TN
37604-3808
US

V. Phone/Fax

Practice location:
  • Phone: 423-979-3494
  • Fax: 423-979-3428
Mailing address:
  • Phone: 423-979-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS0000004242
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: