Provider Demographics
NPI:1962648501
Name:HUFF, DELEEN BODE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DELEEN
Middle Name:BODE
Last Name:HUFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 LOVINGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4421
Mailing Address - Country:US
Mailing Address - Phone:678-371-0485
Mailing Address - Fax:
Practice Address - Street 1:61 WHITCHER ST NE
Practice Address - Street 2:SUITE 4100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1176
Practice Address - Country:US
Practice Address - Phone:770-590-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-04
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005530363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical