Provider Demographics
NPI:1326041930
Name:HUESEMAN, LINDA M (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:HUESEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0011
Mailing Address - Country:US
Mailing Address - Phone:706-769-6469
Mailing Address - Fax:706-769-4402
Practice Address - Street 1:774 ATHENS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648-1908
Practice Address - Country:US
Practice Address - Phone:706-743-8183
Practice Address - Fax:706-743-3233
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00753497BMedicaid
GA00665794AMedicaid
GA083452OtherBCBS OF GEORGIA
GA08BBTPQMedicare ID - Type UnspecifiedMEDICARE
GA00753497BMedicaid
GAG55998Medicare UPIN
GA080190035Medicare ID - Type UnspecifiedRAILROAD MEDICARE