1366672206 NPI number — MS. JACQUELINE DELORES HUGEE CMT

Table of content: MS. JACQUELINE DELORES HUGEE CMT (NPI 1366672206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366672206 NPI number — MS. JACQUELINE DELORES HUGEE CMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUGEE
Provider First Name:
JACQUELINE
Provider Middle Name:
DELORES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REID
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
DELORES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CMT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366672206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4355 OAK MANOR DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACWORTH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30101-5807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-875-1133
Provider Business Mailing Address Fax Number:
757-923-4889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2814 SPRING RD SE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30339-3046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-875-1133
Provider Business Practice Location Address Fax Number:
757-923-4889
Provider Enumeration Date:
07/24/2009

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: 225700000X , with the licence number:  MT003099 , 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)





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