Provider Demographics
NPI:1134584709
Name:HUGHLEY, CASSANDRA DENISE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:DENISE
Last Name:HUGHLEY
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 1:2860 FIELD SPRING DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3851
Mailing Address - Country:US
Mailing Address - Phone:678-387-8076
Mailing Address - Fax:
Practice Address - Street 1:2860 FIELD SPRING DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3851
Practice Address - Country:US
Practice Address - Phone:678-387-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028837596163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health