Provider Demographics
NPI:1366482416
Name:HUFF, MARY MARCELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARCELLA
Last Name:HUFF
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 1:402 MAY STREET
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874
Mailing Address - Country:US
Mailing Address - Phone:423-337-3950
Mailing Address - Fax:423-337-3950
Practice Address - Street 1:886 HIGHWAY 411 N
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1912
Practice Address - Country:US
Practice Address - Phone:423-263-3600
Practice Address - Fax:423-263-3601
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24037207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00821067OtherRAILROAD MCARE THRU AMS
TN3074602Medicaid
TNP00821067OtherRAILROAD MCARE THRU AMS