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General NPI Number Information
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NPI Number | 1659740702
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Entity Type | Organization
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Legal Business Name | ATHENS PEDIATRICS PLLC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 111 EPPERSON ST
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City | ATHENS
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State | TN
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Zip | 37303-3478
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Country | US
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Telephone | 423-745-5955
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Fax | 423-745-6423
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Provider Business Mailing Address
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Address Line | 111 EPPERSON ST
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City | ATHENS
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State | TN
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Zip | 37303-3478
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Country | US
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Telephone | 423-745-5955
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Fax | 423-745-6423
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CINDY ACKAOUY
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Credential |
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Telephone | 423-745-5955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 20337
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License Number State | TN
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