Healthcare Provider Details

I. General information

NPI: 1104506690
Provider Name (Legal Business Name): ATHENS LIMESTONE NEPHROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W MARKET ST STE 16
ATHENS AL
35611-2454
US

IV. Provider business mailing address

1005 W MARKET ST STE 16
ATHENS AL
35611-2454
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-0801
  • Fax: 256-232-5918
Mailing address:
  • Phone: 256-232-0801
  • Fax: 256-232-5918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SEBRINA HOLT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 256-216-9648