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General NPI Number Information
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NPI Number | 1649324930
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Entity Type | Individual
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Provider Name | ATHENA T JOLLY M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 1100 GRAMPIAN BLVD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1909
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Country | US
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Telephone | 570-320-7444
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Fax | 570-320-7445
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Provider Business Mailing Address
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Address Line | 1201 GRAMPIAN BLVD SUITE 1K
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1900
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Country | US
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Telephone | 570-326-8723
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Fax | 570-326-8922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C1-0000709
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | MD043019E
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD043019E
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License Number State | PA
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