Provider Demographics
NPI:1023684826
Name:ATHENA ESOTERIX, LLC.
Entity type:Organization
Organization Name:ATHENA ESOTERIX, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/TECHNICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-645-0007
Mailing Address - Street 1:1247 RIVERFRONT PKWY STE 212
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2108
Mailing Address - Country:US
Mailing Address - Phone:423-206-7091
Mailing Address - Fax:
Practice Address - Street 1:1247 RIVERFRONT PKWY STE 212
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2108
Practice Address - Country:US
Practice Address - Phone:423-206-7091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory