Healthcare Provider Details

I. General information

NPI: 1487278917
Provider Name (Legal Business Name): HUGHSTON MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2257 TAYLOR RD STE 100
MONTGOMERY AL
36117-7797
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 334-245-6605
  • Fax: 334-821-3191
Mailing address:
  • Phone:
  • Fax: 706-494-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: AMANDA FROMKIN
Title or Position: CREDENTIALING MGR
Credential:
Phone: 706-570-0220