Provider Demographics
NPI:1518045319
Name:ATHENA UROLOGY SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ATHENA UROLOGY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-543-6261
Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2188
Mailing Address - Country:US
Mailing Address - Phone:706-543-6261
Mailing Address - Fax:706-543-7060
Practice Address - Street 1:1500 OGLETHORPE AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2188
Practice Address - Country:US
Practice Address - Phone:706-543-6261
Practice Address - Fax:706-543-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical