Provider Demographics
NPI:1467668632
Name:ATHENS REGIONAL PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:ATHENS REGIONAL PHYSICIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHYS PRACTICE SVCS
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:706-475-4921
Mailing Address - Street 1:1270 PRINCE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2185
Mailing Address - Country:US
Mailing Address - Phone:706-475-4917
Mailing Address - Fax:
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-475-4921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0480422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6563OtherMEDICARE GROUP NUMBER
GAGRP6563OtherMEDICARE GROUP NUMBER