Healthcare Provider Details

I. General information

NPI: 1982602801
Provider Name (Legal Business Name): GEORGE R. ATHEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 ELKTON DR SUITE 300
COLORADO SPRINGS CO
80907-8507
US

IV. Provider business mailing address

1115 ELKTON DR SUITE 300
COLORADO SPRINGS CO
80907-8507
US

V. Phone/Fax

Practice location:
  • Phone: 719-268-6992
  • Fax: 719-570-0386
Mailing address:
  • Phone: 719-268-6992
  • Fax: 719-570-0386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number40469
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number40469
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: