Healthcare Provider Details

I. General information

NPI: 1578826988
Provider Name (Legal Business Name): DHP OF GEORGIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 BAXTER ST
ATHENS GA
30606-3712
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY STE 203
KNOXVILLE TN
37919-4053
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 865-693-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN MELISSA TIBEDO
Title or Position: NATIONAL DIRECTOR, ENROLLMENT OPERA
Credential:
Phone: 865-985-7130