Provider Demographics
NPI:1144386475
Name:ATHENS REGIONAL PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:ATHENS REGIONAL PHYSICIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-475-4920
Mailing Address - Street 1:1181 LANGFORD DR
Mailing Address - Street 2:BLDG 100 STE 101
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-2542
Mailing Address - Country:US
Mailing Address - Phone:706-546-9838
Mailing Address - Fax:706-546-9347
Practice Address - Street 1:1181 LANGFORD DR
Practice Address - Street 2:BLDG 100 STE 101
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2542
Practice Address - Country:US
Practice Address - Phone:706-546-9838
Practice Address - Fax:706-546-9347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2970OtherMEDICARE GROUP NUMBER