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General NPI Number Information
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NPI Number | 1255741807
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Entity Type | Organization
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Legal Business Name | ATHENS FAMILY MEDICINE
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 2205 BARNETT SHOALS RD
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City | ATHENS
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State | GA
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Zip | 30605-3605
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Country | US
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Telephone | 706-548-1555
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Fax | 706-548-1577
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Provider Business Mailing Address
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Address Line | 2205 BARNETT SHOALS RD
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City | ATHENS
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State | GA
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Zip | 30605-3605
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Country | US
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Telephone | 706-548-1555
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Fax | 706-548-1577
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Authorized Official
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Title or Position | MD
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Name | PAUL D HAVER
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Credential |
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Telephone | 706-548-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 026381
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 031605
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License Number State | GA
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