Provider Demographics
NPI:1962463646
Name:ATHENS NEPHROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ATHENS NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAUTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DASGUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-546-0083
Mailing Address - Street 1:2047 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6033
Mailing Address - Country:US
Mailing Address - Phone:706-546-0083
Mailing Address - Fax:706-613-9205
Practice Address - Street 1:2047 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6033
Practice Address - Country:US
Practice Address - Phone:706-546-0083
Practice Address - Fax:706-613-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP890Medicare ID - Type UnspecifiedMEDICARE PROVIDER #