Provider Demographics
NPI:1306850144
Name:ATHENS PHYSICIANS PRACTICE LLC
Entity Type:Organization
Organization Name:ATHENS PHYSICIANS PRACTICE LLC
Other - Org Name:MEDICAL ASSOCIATES OF ATHENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:711 COOK DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3486
Mailing Address - Country:US
Mailing Address - Phone:423-746-0122
Mailing Address - Fax:423-745-9456
Practice Address - Street 1:711 COOK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3486
Practice Address - Country:US
Practice Address - Phone:423-746-0122
Practice Address - Fax:423-745-9456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENS PHYSICIANS PRACTICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ3773OtherMEDICARE RAILROAD
TN3374004Medicaid
TN=========OtherTAX ID
CJ3773OtherMEDICARE RAILROAD