Provider Demographics
NPI:1548655137
Name:HUFFMAN, MILA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MILA
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SUNSET DR STE 100A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2293
Mailing Address - Country:US
Mailing Address - Phone:706-548-6068
Mailing Address - Fax:706-354-1218
Practice Address - Street 1:700 SUNSET DR STE 100A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2293
Practice Address - Country:US
Practice Address - Phone:706-548-6068
Practice Address - Fax:706-354-1218
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127830363LA2200X
GARN262881363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003208302AMedicaid