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General NPI Number Information
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NPI Number | 1487704540
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Entity Type | Organization
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Legal Business Name | ATHENA COMPLETE CARE LLC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 727 W MARKET ST SUITE 5
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City | ATHENS
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State | AL
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Zip | 35611-2456
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Country | US
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Telephone | 256-262-4970
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Fax | 256-262-4971
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Provider Business Mailing Address
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Address Line | PO BOX 66
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City | TANNER
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State | AL
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Zip | 35671-0066
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ASHLEY BAILEY POOL
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Credential | CRNP
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Telephone | 256-262-4970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1-087387
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License Number State | AL
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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 | 18295
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License Number State | AL
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