Provider Demographics
NPI:1578803755
Name:ATHENS AREA UROLOGY, PC
Entity Type:Organization
Organization Name:ATHENS AREA UROLOGY, PC
Other - Org Name:ATHENS AREA UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-612-9401
Mailing Address - Street 1:1150 GOLDEN WAY
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7712
Mailing Address - Country:US
Mailing Address - Phone:706-612-9401
Mailing Address - Fax:706-612-9420
Practice Address - Street 1:1150 GOLDEN WAY
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7712
Practice Address - Country:US
Practice Address - Phone:706-612-9401
Practice Address - Fax:706-612-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003133756AMedicaid