Healthcare Provider Details

I. General information

NPI: 1295611556
Provider Name (Legal Business Name): ATHENS MODEL NEIGHBORHOOD HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 COLLEGE AVE
ATHENS GA
30601-2635
US

IV. Provider business mailing address

402 MCKINLEY DR
ATHENS GA
30601-3261
US

V. Phone/Fax

Practice location:
  • Phone: 706-546-5526
  • Fax: 706-546-5687
Mailing address:
  • Phone: 706-543-1145
  • Fax: 706-549-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMAN KAZEMI
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 706-543-1145