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General NPI Number Information
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NPI Number | 1699625038
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Entity Type | Individual
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Provider Name | DAVID ALEXANDER ATHAY
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Gender | Male
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Dates
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Enumeration Date | 02/03/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 1000 HEALTH CENTER DR
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City | MATTOON
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State | IL
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Zip | 61938-4644
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Country | US
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Telephone | 360-989-0283
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Fax |
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Provider Business Mailing Address
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Address Line | 2775 PEARCE PT
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City | NEWBURGH
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State | IN
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Zip | 47630-9047
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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 |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209.034664
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License Number State | IL
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