Provider Demographics
NPI:1457841900
Name:HUGHSTON CLINIC PC
Entity Type:Organization
Organization Name:HUGHSTON CLINIC PC
Other - Org Name:THE HUGHSTON CLINIC, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENCHWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-494-3193
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:706-494-3193
Mailing Address - Fax:
Practice Address - Street 1:100 N MACON ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-6563
Practice Address - Country:US
Practice Address - Phone:706-324-6661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies