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General NPI Number Information
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NPI Number | 1164926739
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Entity Type | Organization
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Legal Business Name | ATHENS HEART CENTER, PC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 1999 PRINCE AVE
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City | ATHENS
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State | GA
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Zip | 30606-6013
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Country | US
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Telephone | 706-356-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 PRINCE AVE
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City | ATHENS
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State | GA
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Zip | 30606-6032
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Country | US
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Telephone | 706-356-8181
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Fax |
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Authorized Official
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Title or Position | MD
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Name | SUBODH K AGRAWAL
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Credential | MD
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Telephone | 706-208-8258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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