Provider Demographics
NPI:1497999874
Name:ATHENS PEDIATRIC THERAPY, INC.
Entity Type:Organization
Organization Name:ATHENS PEDIATRIC THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:706-202-0458
Mailing Address - Street 1:110 GREYSTONE TER
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-4460
Mailing Address - Country:US
Mailing Address - Phone:706-202-0458
Mailing Address - Fax:706-353-1606
Practice Address - Street 1:110 GREYSTONE TER
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-4460
Practice Address - Country:US
Practice Address - Phone:706-202-0458
Practice Address - Fax:706-353-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty