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NPI Code Detail

MEDICARE: ATHENS ENDOSCOPY, LLC

MEDICARE: ATHENS ENDOSCOPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0800XEndoscopy Clinic/Center029-441GA

General Provider Information

NPI Number : 1558662858
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATHENS ENDOSCOPY, LLC
Provider Business Mailing Address
First Line : 21 JEFFERSON PL STE 2
Second Line :
City : ATHENS
State : GA
Zip : 30601-1761
Country : US
Telephone Number : 706-433-0788
Fax Number : 706-548-4801
Provider Business Practice Location Address
First Line : 21 JEFFERSON PL STE 2
Second Line :
City : ATHENS
State : GA
Zip : 30601-1761
Country : US
Telephone Number : 706-433-0788
Fax Number : 706-433-0786
Authorized Official
Title or Position : BUSINESS ADMINISTRATOR
Name : MS. TANDEKAH SCOTT
Credential :
Telephone Number : 706-548-0446
Provider Enumeration Date : 11/03/2010
Last Update Date : 08/03/2011

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