Healthcare Provider Details

I. General information

NPI: 1225401946
Provider Name (Legal Business Name): HUGHSTON CLINIC SOUTHEAST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262 VETERANS PKWY
COLUMBUS GA
31909-3540
US

IV. Provider business mailing address

6262 VETERANS PKWY
COLUMBUS GA
31909-3540
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-6661
  • Fax:
Mailing address:
  • Phone: 706-494-3193
  • Fax: 706-494-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: MARLA MCMEANS
Title or Position: SYS DIR OF CREDENTIALING
Credential:
Phone: 706-494-3171