Provider Demographics
NPI:1548961279
Name:DOUGLAS, HUGHIE DILLON (FNP-C)
Entity type:Individual
Prefix:
First Name:HUGHIE
Middle Name:DILLON
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 HWY 341
Mailing Address - Street 2:
Mailing Address - City:CHAUNCEY
Mailing Address - State:GA
Mailing Address - Zip Code:31011-3865
Mailing Address - Country:US
Mailing Address - Phone:229-868-8625
Mailing Address - Fax:
Practice Address - Street 1:200 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2997
Practice Address - Country:US
Practice Address - Phone:478-274-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily