Provider Demographics
NPI:1629780838
Name:MAFFETT, ANNESSA W
Entity Type:Individual
Prefix:MRS
First Name:ANNESSA
Middle Name:W
Last Name:MAFFETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 THICKET WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3737
Mailing Address - Country:US
Mailing Address - Phone:404-422-6206
Mailing Address - Fax:
Practice Address - Street 1:1002 THICKET WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3737
Practice Address - Country:US
Practice Address - Phone:404-422-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030048933251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health