Provider Demographics
NPI:1801278486
Name:HUFFMAN, EMILY DENISE (FNP-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:DENISE
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:DENISE
Other - Last Name:PHAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-534-0110
Practice Address - Fax:770-534-2555
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA03111123OtherAMERIGROUP
GA003162060EMedicaid
GA1137849OtherWELLCARE
GA003162060AMedicaid