Basic Information
| Provider Information | |||||||||
| NPI: | 1831205210 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATHENS MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1660 LAFAYETTE RD | ||||||||
| Address2: | 100 | ||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479334601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653591660 | ||||||||
| FaxNumber: | 7653592233 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 LAFAYETTE RD | ||||||||
| Address2: | 100 | ||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479334601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653591660 | ||||||||
| FaxNumber: | 7653592233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | DANIEL | ||||||||
| AuthorizedOfficialFirstName: | TERESA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EX DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7653645360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.