Provider Demographics
NPI:1689977761
Name:ATHENS SLEEP AND WELLNESS CENTER
Entity Type:Organization
Organization Name:ATHENS SLEEP AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBODH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-613-6990
Mailing Address - Street 1:2005 PRINCE AVE.
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6032
Mailing Address - Country:US
Mailing Address - Phone:706-208-9700
Mailing Address - Fax:706-208-0806
Practice Address - Street 1:1490 PRINCE AVE.
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2210
Practice Address - Country:US
Practice Address - Phone:706-613-6990
Practice Address - Fax:706-613-6989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHENS HEART CENTER DBA ATHENS SLEEP & WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-13
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028344207RS0012X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty