Healthcare Provider Details

I. General information

NPI: 1003801184
Provider Name (Legal Business Name): PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 PRINCE AVE
ATHENS GA
30606-6006
US

IV. Provider business mailing address

1510 PRINCE AVE
ATHENS GA
30606-6006
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-5500
  • Fax: 706-475-5570
Mailing address:
  • Phone: 706-475-5563
  • Fax: 706-475-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberPHRE008281
License Number StateGA

VIII. Authorized Official

Name: WENDY JOHNSON COOK
Title or Position: CFO
Credential:
Phone: 706-475-5563