Basic Information
| Provider Information | |||||||||
| NPI: | 1699951897 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUGHSTON CLINIC PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE HUGHSTON CLINIC PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6262 VETERANS PKWY | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319093540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064943193 | ||||||||
| FaxNumber: | 7064943201 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 OAKLAND PKWY | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317637201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066464371 | ||||||||
| FaxNumber: | 7066464372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2008 | ||||||||
| LastUpdateDate: | 10/25/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7064943290 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.