Basic Information
Provider Information
NPI: 1346678430
EntityType: 2
ReplacementNPI:  
OrganizationName: ATHENS REGIONAL MEDICAL CENTER LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: STARR REGIONAL MEDICAL CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 330 SEVEN SPRINGS WAY
Address2:  
City: BRENTWOOD
State: TN
PostalCode: 370274536
CountryCode: US
TelephoneNumber: 6159207000
FaxNumber: 6159208913
Practice Location
Address1: 1114 W MADISON AVE
Address2:  
City: ATHENS
State: TN
PostalCode: 373034150
CountryCode: US
TelephoneNumber: 4237451411
FaxNumber: 4237443362
Other Information
ProviderEnumerationDate: 10/29/2013
LastUpdateDate: 04/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DILLON
AuthorizedOfficialFirstName: TERRANCE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: ASSISTANT SECRETARY
AuthorizedOfficialTelephone: 5025967220
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: ATHENS REGIONAL MEDICAL CENTER LLC
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/26/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
273R00000X  Y Hospital UnitsPsychiatric Unit 

No ID Information.


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