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NPI Code Detail

MEDICARE: HUGHSTON CLINIC SOUTHEAST PC

MEDICARE: HUGHSTON CLINIC SOUTHEAST PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical SuppliesTN

General Provider Information

NPI Number : 1770004863
Entity Type Code : Organization
Provider Name (Legal Business Name) : HUGHSTON CLINIC SOUTHEAST PC
Provider Business Mailing Address
First Line : PO BOX 370
Second Line :
City : FORTSON
State : GA
Zip : 31808-0370
Country : US
Telephone Number : 706-494-6661
Fax Number : 706-494-3008
Provider Business Practice Location Address
First Line : 3443 DICKERSON PIKE STE 190B
Second Line :
City : NASHVILLE
State : TN
Zip : 37207-2533
Country : US
Telephone Number : 615-301-8269
Fax Number : 615-712-9823
Authorized Official
Title or Position : CRED COORD
Name : AMANDA FROMKIN
Credential :
Telephone Number : 706-494-3071
Provider Enumeration Date : 06/29/2017
Last Update Date : 08/18/2023

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Directions to “HUGHSTON CLINIC SOUTHEAST PC ” Practice Location

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