Organization
HUGHSTON CLINIC SOUTHEAST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA GRACE FROMKIN (DIRECTOR OF CREDENTIALING)
(706) 494-3071
Entity
Organization
Contact information
Practice address
3627 UNIVERSITY BLVD S STE 550, JACKSONVILLE, FL 32216-7401
(904) 570-8604
(904) 458-4819
Mailing address
6262 VETERANS PKWY, COLUMBUS, GA 31909-3540
(706) 494-3071
(706) 494-3008
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
FL
Other
Enumeration date
07/12/2018
Last updated
08/18/2023
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