Healthcare Provider Details

I. General information

NPI: 1093932683
Provider Name (Legal Business Name): ATHENS MODEL NEIGHBORHOOD HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 COLLEGE AVE
ATHENS GA
30601
US

IV. Provider business mailing address

675 COLLEGE AVE
ATHENS GA
30601-2635
US

V. Phone/Fax

Practice location:
  • Phone: 706-546-5526
  • Fax: 706-546-5687
Mailing address:
  • Phone: 706-546-5526
  • Fax: 706-546-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LINDA M CHERRY
Title or Position: HUMAN RESOURCE DIRECTOR
Credential:
Phone: 762-499-6960