1326041930 NPI number — LINDA M HUESEMAN M.D.

Table of content: LINDA M HUESEMAN M.D. (NPI 1326041930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326041930 NPI number — LINDA M HUESEMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUESEMAN
Provider First Name:
LINDA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326041930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATKINSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30677-0011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-769-6469
Provider Business Mailing Address Fax Number:
706-769-4402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
774 ATHENS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30648-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-743-8183
Provider Business Practice Location Address Fax Number:
706-743-3233
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  043655 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00753497B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00665794A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 083452 . This is a "BCBS OF GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com