Provider Demographics
NPI:1225147085
Name:ATHEY, GEORGE JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:ATHEY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 SW WANAMAKER DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5318
Mailing Address - Country:US
Mailing Address - Phone:785-272-5566
Mailing Address - Fax:785-272-5967
Practice Address - Street 1:2955 SW WANAMAKER DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5318
Practice Address - Country:US
Practice Address - Phone:785-272-5566
Practice Address - Fax:785-272-5967
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS301103G00000X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119657OtherBLUE SHIELD OF KS
KS119657Medicare ID - Type UnspecifiedMEDICARE