# HUGHSTON CLINIC SOUTHEAST, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HUGHSTON CLINIC SOUTHEAST PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912519505
- **Legal business name:** HUGHSTON CLINIC SOUTHEAST PC
- **Authorized official:** AMANDA FROMKIN (CREDENTIALING MANAGER)
- **Authorized official phone:** (706) 570-0220

## Contact information

- **Practice address:** 819 E OAK ST STE A, KISSIMMEE, FL 34744-5842
- **Practice address phone:** (407) 476-0780
- **Practice address fax:** (407) 476-0785
- **Mailing address:** PO BOX 370, FORTSON, GA 31808-0370
- **Mailing address phone:** (706) 570-0220
- **Mailing address fax:** (706) 494-3008

## Taxonomy

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

## Other

- **Enumeration date:** 08/17/2020
- **Last updated:** 08/17/2020