Basic Information
| Provider Information | |||||||||
| NPI: | 1689120727 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUGHSTON CLINIC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6262 VETERANS PKWY | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319093540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064943071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 HIGHWAY 70 E | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | DICKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370552080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154551966 | ||||||||
| FaxNumber: | 6154551965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | FROMKIN | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | GRACE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7064943071 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | TN | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.