Healthcare Provider Details

I. General information

NPI: 1457725152
Provider Name (Legal Business Name): ATHENS NEIGHBORHOOD HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 OLD JEFFERSON RD BUILDING 300
ATHENS GA
30607
US

IV. Provider business mailing address

P O BOX 147
ATHENS GA
30603
US

V. Phone/Fax

Practice location:
  • Phone: 706-850-9041
  • Fax:
Mailing address:
  • Phone: 762-499-6961
  • Fax: 706-850-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number29631
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ALMENA SMITH
Title or Position: BILLING MANAGER
Credential:
Phone: 762-499-6961