Provider Demographics
NPI:1942442165
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-494-3290
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 1:522 NORTH CENTER STREET
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-4371
Practice Address - Country:US
Practice Address - Phone:706-646-4371
Practice Address - Fax:706-646-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4725880013Medicare NSC
GA4725880013Medicare NSC