MEDICARE: ATHENS AREA PEDIATRICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	037368	GA

General Provider Information

NPI Number	:	1518452150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENS AREA PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	225 HAWTHORNE PARK
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-2151
Country	:	US
Telephone Number	:	706-613-6136
Fax Number	:	706-543-0706

Provider Business Practice Location Address
First Line	:	225 HAWTHORNE PARK
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-2151
Country	:	US
Telephone Number	:	706-613-6136
Fax Number	:	706-543-0706

Authorized Official
Title or Position	:	OWNER ATHENS AREA PEDIATRICS LLC
Name	:	DR. RAJIV KUMAR SETIA
Credential	:	MD
Telephone Number	:	706-613-6136

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	06/26/2018

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