Basic Information
| Provider Information | |||||||||
| NPI: | 1477983013 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUGHSTON CLINIC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6262 VETERANS PKWY | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319099517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064943193 | ||||||||
| FaxNumber: | 7064943201 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 10TH AVE | ||||||||
| Address2: | SUITE 270 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065711011 | ||||||||
| FaxNumber: | 7069926595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2013 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7064943290 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.