# HUGHSTON CLINIC SOUTHEAST PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487130571
- **Authorized official:** AMANDA GRACE FROMKIN (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (706) 494-3071

## Contact information

- **Practice address:** 309 N MANGOUSTINE AVE UNIT G, SANFORD, FL 32771-1098
- **Practice address phone:** (321) 363-1754
- **Practice address fax:** (321) 363-3336
- **Mailing address:** 6262 VETERANS PKWY, COLUMBUS, GA 31909-3540
- **Mailing address phone:** (706) 494-3071
- **Mailing address fax:** (706) 494-3008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | FL | Yes |

## Other

- **Enumeration date:** 07/12/2018
- **Last updated:** 08/18/2023