Provider Demographics
NPI:1538189295
Name:HUSKEY, CICILY MONTENA (NP)
Entity type:Individual
Prefix:
First Name:CICILY
Middle Name:MONTENA
Last Name:HUSKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 BELLFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6927
Mailing Address - Country:US
Mailing Address - Phone:678-624-0044
Mailing Address - Fax:
Practice Address - Street 1:4350 TOWNE CENTRE DR STE 1100
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3329
Practice Address - Country:US
Practice Address - Phone:706-863-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138231207RC0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA979120850GMedicaid
GA979120850DMedicaid
GA979120850IMedicaid
GA0371565-22OtherBOARD CERTIFICATION
GA979120850IMedicaid