Active NPI
Lisa P Huckaby, CNM
- Midwife
- Conyers, GA
National Provider Identifier
1437112372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- RN069461
- Practice address
- 1301 Sigman Rd NE
Suite 230
Conyers, GA 30012-3812 - Phone
- (678) 609-4931
- Fax
- (678) 609-4932
- NPI assigned
- Apr 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | RN069461 | GA | Primary |
Addresses
Primary practice location
1301 Sigman Rd NE
Suite 230
Conyers, GA 30012-3812
Mailing address
2755 Ebenezer Rd SE
Conyers, GA 30094-3201
Phone (770) 483-0110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00892438 | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN069461 | GA | MD | Midwife |
| 069461 | GA | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1279670400000",
"number": "1437112372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2755 EBENEZER RD SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300943201",
"telephone_number": "770-483-0110",
"fax_number": "678-609-4931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 SIGMAN RD NE",
"address_2": "SUITE 230",
"city": "CONYERS",
"state": "GA",
"postal_code": "300123812",
"telephone_number": "678-609-4931",
"fax_number": "678-609-4932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUCKABY",
"first_name": "LISA",
"middle_name": "P",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-11",
"last_updated": "2010-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "GA",
"license": "RN069461",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00892438",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.