Healthcare Provider Details

I. General information

NPI: 1841776937
Provider Name (Legal Business Name): HUGHSTON CLINIC SOUTHEAST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 09/25/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DOCTORS DRIVE MEDICAL PLAZA 2
PANAMA CITY FL
32405-4590
US

IV. Provider business mailing address

6262 VETERANS PKWY
COLUMBUS GA
31909-3540
US

V. Phone/Fax

Practice location:
  • Phone: 850-767-2455
  • Fax:
Mailing address:
  • Phone: 706-494-3071
  • 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 StateFL

VIII. Authorized Official

Name: MARLA MCMEANS
Title or Position: SYSTEM DIRECTOR OF CREDENTIALING
Credential:
Phone: 706-494-3171