Provider Demographics
NPI:1629510011
Name:HUGGINS MEDICAL GROUP
Entity Type:Organization
Organization Name:HUGGINS MEDICAL GROUP
Other - Org Name:HUGGINS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-682-1131
Mailing Address - Street 1:6934 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1604
Mailing Address - Country:US
Mailing Address - Phone:770-702-7728
Mailing Address - Fax:
Practice Address - Street 1:6934 BROAD ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1604
Practice Address - Country:US
Practice Address - Phone:770-702-7728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000512784DMedicaid
GA000512784DMedicaid