Provider Demographics
NPI:1437382686
Name:HUSTON, PAULA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:HUSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MARIE
Other - Last Name:MEENEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:330 TURNER MCCALL BLVD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-5630
Practice Address - Country:US
Practice Address - Phone:706-238-8030
Practice Address - Fax:706-238-8031
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA011118912AMedicaid
GA011118912CMedicaid
GA011118912BMedicaid
GA011118912AMedicaid