Provider Demographics
NPI:1891918934
Name:ATHENS GERIATRICS AND INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:ATHENS GERIATRICS AND INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:PARADELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-549-8931
Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2179
Mailing Address - Country:US
Mailing Address - Phone:706-549-8931
Mailing Address - Fax:706-549-0088
Practice Address - Street 1:1500 OGLETHORPE AVE
Practice Address - Street 2:SUITE 3200
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2179
Practice Address - Country:US
Practice Address - Phone:706-549-8931
Practice Address - Fax:706-549-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049200207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty