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General NPI Number Information
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NPI Number | 1902026347
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Entity Type | Organization
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Legal Business Name | ATHENS BEHAVIORAL MEDICINE
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1361 JENNINGS MILL RD STE 201
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City | BOGART
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State | GA
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Zip | 30622-2592
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Country | US
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Telephone | 706-316-1908
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Fax | 706-316-2062
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Provider Business Mailing Address
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Address Line | 1361 JENNINGS MILL RD SUITE 201
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City | BOGART
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State | GA
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Zip | 30622-2592
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Country | US
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Telephone | 706-316-1908
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Fax | 706-316-2062
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Authorized Official
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Title or Position | BILLING
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Name | SUSIE WATKINS
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Credential |
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Telephone | 709-316-1908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 051255
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License Number State | GA
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