Organization
HUGHSTON CLINIC SOUTHEAST, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA FROMKIN (CREDENTIALING MANAGER)
(706) 494-3071
Entity
Organization
Contact information
Practice address
4689 HWY 17, STE 12, FLEMING ISLAND, FL 32003-4831
(904) 375-8850
(904) 458-4819
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE PTAN
FL
Enumeration date
07/17/2020
Last updated
08/18/2023
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