Individual
LISA P HUCKABY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
1301 SIGMAN RD NE, SUITE 230, CONYERS, GA 30012-3812
(678) 609-4931
(678) 609-4932
Mailing address
2755 EBENEZER RD SE, CONYERS, GA 30094-3201
(770) 483-0110
(678) 609-4931
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
RN069461
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00892438
—
GA
Enumeration date
04/11/2006
Last updated
07/21/2010
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