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General NPI Number Information
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NPI Number | 1487865952
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Entity Type | Organization
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Legal Business Name | ATHENS DIABETES AND ENDOCRINOLOGY
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 3320 OLD JEFFERSON RD STE 600
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City | ATHENS
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State | GA
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Zip | 30607-1463
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Country | US
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Telephone | 706-549-4155
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Fax | 706-546-0036
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Provider Business Mailing Address
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Address Line | 3320 OLD JEFFERSON RD STE 600
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City | ATHENS
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State | GA
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Zip | 30607-1463
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Country | US
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Telephone | 706-549-4155
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Fax | 706-546-0036
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER FRANDSEN VANDYCK
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Credential | MD
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Telephone | 706-549-4155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 27679
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License Number State | GA
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