Provider Demographics
NPI:1508134610
Name:HUGHLEY, TABITHA NICHOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:TABITHA
Middle Name:NICHOLE
Last Name:HUGHLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4576 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1447
Mailing Address - Country:US
Mailing Address - Phone:404-905-9153
Mailing Address - Fax:404-381-2379
Practice Address - Street 1:4576 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1447
Practice Address - Country:US
Practice Address - Phone:404-905-9153
Practice Address - Fax:404-381-2379
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor