Provider Demographics
NPI:1639224017
Name:ATHENS MATERNAL-FETAL MEDICINE, PC
Entity Type:Organization
Organization Name:ATHENS MATERNAL-FETAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROSEMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-549-0087
Mailing Address - Street 1:700 SUNSET DR STE 301
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7721
Mailing Address - Country:US
Mailing Address - Phone:706-549-0087
Mailing Address - Fax:706-208-0680
Practice Address - Street 1:700 SUNSET DR STE 301
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7721
Practice Address - Country:US
Practice Address - Phone:706-549-0087
Practice Address - Fax:706-208-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038937207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00621596DMedicaid
GAE50698Medicare UPIN
GA06BDTTRMedicare ID - Type Unspecified