Healthcare Provider Details

I. General information

NPI: 1467668632
Provider Name (Legal Business Name): ATHENS REGIONAL PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

1270 PRINCE AVE SUITE 301
ATHENS GA
30606-2185
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-4921
  • Fax:
Mailing address:
  • Phone: 706-475-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number048042
License Number StateGA

VIII. Authorized Official

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