Provider Demographics
NPI:1730385642
Name:HUEY, JOHN A (NMTCB)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:HUEY
Suffix:
Gender:M
Credentials:NMTCB
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:314 BERKLEY DR
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-2415
Mailing Address - Country:US
Mailing Address - Phone:678-384-1711
Mailing Address - Fax:678-384-1721
Practice Address - Street 1:5604 WENDY BAGWELL PKWY
Practice Address - Street 2:SUITE 911
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7809
Practice Address - Country:US
Practice Address - Phone:678-384-1711
Practice Address - Fax:678-384-1721
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0260372471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA026037OtherNMTCB