Provider Demographics
NPI:1073532123
Name:ATHENS PHYSICIANS PRACTICE LLC
Entity Type:Organization
Organization Name:ATHENS PHYSICIANS PRACTICE LLC
Other - Org Name:WILLIAM R. BOWERS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:P.O. BOX 906
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371
Mailing Address - Country:US
Mailing Address - Phone:423-745-1277
Mailing Address - Fax:423-745-2188
Practice Address - Street 1:719 COOK DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303
Practice Address - Country:US
Practice Address - Phone:423-745-1277
Practice Address - Fax:423-745-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ3772OtherMEDICARE RAILROAD
TN3374005Medicaid
TN=========OtherTAX ID
CJ3772OtherMEDICARE RAILROAD