Healthcare Provider Details

I. General information

NPI: 1740431253
Provider Name (Legal Business Name): ATHENS REGIONAL PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OGLETHORPE AVE SUITE 2500
ATHENS GA
30606-2179
US

IV. Provider business mailing address

1500 OGLETHORPE AVE BLDG 600A
ATHENS GA
30606-2179
US

V. Phone/Fax

Practice location:
  • Phone: 706-548-7909
  • Fax:
Mailing address:
  • Phone: 706-475-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN RODKEY
Title or Position: DIRECTOR
Credential:
Phone: 706-475-4921