Healthcare Provider Details

I. General information

NPI: 1366520165
Provider Name (Legal Business Name): UROLOGY GROUP OF ATHENS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 PRINCE AVE
ATHENS GA
30606-6030
US

IV. Provider business mailing address

2317 PRINCE AVE
ATHENS GA
30606-6030
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-6261
  • Fax: 706-543-7060
Mailing address:
  • Phone: 706-543-6261
  • Fax: 706-543-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateGA

VIII. Authorized Official

Name: JOHN C BLANKENSHIP
Title or Position: OWNER
Credential:
Phone: 706-543-6261