Provider Demographics
NPI:1235642893
Name:SECD ATHENS
Entity Type:Organization
Organization Name:SECD ATHENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:BRITTANY
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-434-7115
Mailing Address - Street 1:4320 MONTEVALLO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2722
Mailing Address - Country:US
Mailing Address - Phone:205-434-7115
Mailing Address - Fax:
Practice Address - Street 1:22051 HWY 72 EAST
Practice Address - Street 2:F
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-3561
Practice Address - Country:US
Practice Address - Phone:256-262-0600
Practice Address - Fax:256-233-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental