Provider Demographics
NPI:1508212390
Name:PIEDMONT ATHENS REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PIEDMONT ATHENS REGIONAL MEDICAL CENTER INC
Other - Org Name:OCONEE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OUTPATIENT PHCY, AO
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-475-5563
Mailing Address - Street 1:PO BOX 162763
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30321-2763
Mailing Address - Country:US
Mailing Address - Phone:706-552-1720
Mailing Address - Fax:706-552-1721
Practice Address - Street 1:1305 JENNINGS MILL RD
Practice Address - Street 2:BUILDING 100, SUITE 100
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677
Practice Address - Country:US
Practice Address - Phone:706-552-1720
Practice Address - Fax:706-552-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0103393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168317OtherPK