Provider Demographics
NPI:1003801184
Name:PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC.
Other - Org Name:PIEDMONT HOME INFUSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-475-5563
Mailing Address - Street 1:1510 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6006
Mailing Address - Country:US
Mailing Address - Phone:706-475-5563
Mailing Address - Fax:706-475-5565
Practice Address - Street 1:1510 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6006
Practice Address - Country:US
Practice Address - Phone:706-475-5500
Practice Address - Fax:706-475-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008281251F00000X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00801798BMedicaid
GA1257520001Medicare NSC