Provider Demographics
NPI:1164461190
Name:HUGHSTON CLINIC, P.C.
Entity Type:Organization
Organization Name:HUGHSTON CLINIC, P.C.
Other - Org Name:THE HUGHSTON CLINIC, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING MGR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-494-3071
Mailing Address - Street 1:6262 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-9517
Mailing Address - Country:US
Mailing Address - Phone:706-494-3193
Mailing Address - Fax:706-494-3201
Practice Address - Street 1:6262 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-9517
Practice Address - Country:US
Practice Address - Phone:706-324-6661
Practice Address - Fax:706-494-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP986Medicare PIN
ALD015Medicare PIN