=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316957939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE ALLISON HUGGINS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 10/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6934 BROAD ST
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30134-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-702-7728
-----------------------------------------------------
Fax | 770-726-7265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6934 BROAD ST
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30134-1839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-682-1131
-----------------------------------------------------
Fax | 770-726-7265
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 034368
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------