Provider Demographics
NPI:1982827515
Name:HUCKABY, JANICE BUTCHER (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:BUTCHER
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CADILLAC DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5078
Mailing Address - Country:US
Mailing Address - Phone:615-372-3622
Mailing Address - Fax:813-372-3640
Practice Address - Street 1:10 CADILLAC DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5078
Practice Address - Country:US
Practice Address - Phone:615-372-3622
Practice Address - Fax:813-372-3640
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31089207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF40135Medicare UPIN