Provider Demographics
NPI:1114226719
Name:HUCKINS HEALTHCARE, PC
Entity Type:Organization
Organization Name:HUCKINS HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUCKINS-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-364-0900
Mailing Address - Street 1:3121 E SHADOWLAWN AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2405
Mailing Address - Country:US
Mailing Address - Phone:404-364-0900
Mailing Address - Fax:404-364-9030
Practice Address - Street 1:3121 E SHADOWLAWN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2405
Practice Address - Country:US
Practice Address - Phone:404-364-0900
Practice Address - Fax:404-364-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005803261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU66792Medicare UPIN