Provider Demographics
NPI:1558394981
Name:ATHENS INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:ATHENS INTERNAL MEDICINE PC
Other - Org Name:ALBERT PATRICK BROOKS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-548-8600
Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:STE 400A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-548-8600
Mailing Address - Fax:706-548-1655
Practice Address - Street 1:1500 OGLETHORPE AVE
Practice Address - Street 2:STE 400A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-548-8600
Practice Address - Fax:706-548-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA022758OtherLICENSE
GA022724OtherLICENSE
GA00250885CMedicaid
GA052022OtherLICENSE
GA00964741AMedicaid
GA00250907BMedicaid
GA057497OtherSTATE LICENSE
GA00964741AMedicaid
GA00250907BMedicaid
GA057497OtherSTATE LICENSE
AB1227087OtherDEA
GA052022OtherLICENSE
D29476Medicare UPIN
GA00250907BMedicaid
BS6695095OtherDEA
AF1353438OtherDEA
AB1227087OtherDEA