Provider Demographics
NPI:1437128063
Name:ATHENS WELLNESS DIAGNOSTICS
Entity Type:Organization
Organization Name:ATHENS WELLNESS DIAGNOSTICS
Other - Org Name:AMERICAN WELLNESS DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENSCHIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:281-381-8838
Mailing Address - Street 1:3100 TIMMONS LN
Mailing Address - Street 2:SUITE 320
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5926
Mailing Address - Country:US
Mailing Address - Phone:281-381-8838
Mailing Address - Fax:866-241-8647
Practice Address - Street 1:1490 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2210
Practice Address - Country:US
Practice Address - Phone:706-613-6990
Practice Address - Fax:706-613-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018110261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000895353DMedicaid
GA52821081OtherBCBS
GA47BBBGTMedicare PIN