Healthcare Provider Details

I. General information

NPI: 1760609218
Provider Name (Legal Business Name): ATHENS WOMENS CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COOK DR
ATHENS TN
37303-3485
US

IV. Provider business mailing address

817 COOK DR
ATHENS TN
37303-3485
US

V. Phone/Fax

Practice location:
  • Phone: 423-745-3394
  • Fax: 423-745-4496
Mailing address:
  • Phone: 423-745-3394
  • Fax: 423-745-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT EUGENE BLEDSOE JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 423-745-3394