Basic Information
| Provider Information | |||||||||
| NPI: | 1740431253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATHENS REGIONAL PHYSICIAN SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 OGLETHORPE AVE | ||||||||
| Address2: | BLDG 600A | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064754920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 OGLETHORPE AVE | ||||||||
| Address2: | SUITE 2500 | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065487909 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2008 | ||||||||
| LastUpdateDate: | 10/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | RODKEY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7064754921 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.