Organization
HUGHSTON MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA FROMKIN (CREDENTIALING MGR)
(706) 570-0220
Entity
Organization
Contact information
Practice address
2257 TAYLOR RD STE 100, MONTGOMERY, AL 36117-7797
(334) 245-6605
(334) 821-3191
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3008
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
AL
Enumeration date
06/01/2020
Last updated
08/18/2023
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