Healthcare Provider Details

I. General information

NPI: 1275982472
Provider Name (Legal Business Name): ATHENS CONCUSSION & NEUROPSYCHOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RESEARCH DR STE C
ATHENS GA
30605-2779
US

IV. Provider business mailing address

575 RESEARCH DR STE C
ATHENS GA
30605-2779
US

V. Phone/Fax

Practice location:
  • Phone: 706-214-1427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY003555
License Number StateGA

VIII. Authorized Official

Name: DR. KATHERINE FINLEY
Title or Position: OWNER
Credential: PHD
Phone: 706-214-1427