Provider Demographics
NPI:1316957939
Name:HUGGINS, MICHELLE ALLISON (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALLISON
Last Name:HUGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6934 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1839
Mailing Address - Country:US
Mailing Address - Phone:678-682-1131
Mailing Address - Fax:770-726-7265
Practice Address - Street 1:6934 BROAD ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1604
Practice Address - Country:US
Practice Address - Phone:770-702-7728
Practice Address - Fax:770-726-7265
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA034368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000512784DMedicaid
GA11SCFDJMedicare PIN
GA000512784DMedicaid