Healthcare Provider Details

I. General information

NPI: 1710390109
Provider Name (Legal Business Name): LEE M HUGHES NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEE M HUGHES RN

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 SUMTER ST
MONTEZUMA GA
31063-1734
US

IV. Provider business mailing address

509 SUMTER ST OFC
MONTEZUMA GA
31063-1733
US

V. Phone/Fax

Practice location:
  • Phone: 478-472-8178
  • Fax: 478-472-3289
Mailing address:
  • Phone: 478-472-3154
  • Fax: 478-472-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN225465
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN225465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: