Healthcare Provider Details

I. General information

NPI: 1104852706
Provider Name (Legal Business Name): ATHENS THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 JENNINGS MILL RD SUITE 1700A
BOGART GA
30622-2544
US

IV. Provider business mailing address

1551 JENNINGS MILL RD SUITE 1700A
BOGART GA
30622-2544
US

V. Phone/Fax

Practice location:
  • Phone: 706-369-9099
  • Fax: 706-369-1656
Mailing address:
  • Phone: 706-369-9099
  • Fax: 706-369-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005140
License Number StateGA

VIII. Authorized Official

Name: MR. JOSEPH AVOLIO
Title or Position: OWNER
Credential: P.T.
Phone: 706-369-9099