Organization
HUGHSTON CLINIC SOUTHEAST, PC
Active
Parent organization
HUGHSTON CLINIC SOUTHEAST, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
HUGHSTON CLINIC SOUTHEAST, PC
Authorized official
AMANDA FROMKIN (CREDENTIALING MANAGER)
(706) 494-3071
Entity
Organization
Contact information
Practice address
3443 DICKERSON PIKE STE 190, NASHVILLE, TN 37207-2533
(615) 301-8269
(615) 712-9823
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3008
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100579610
—
KY
Enumeration date
08/17/2020
Last updated
08/17/2020
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