Provider Demographics
NPI:1639421704
Name:PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO-PIEDMONT ATHENS REGIONAL MEDICA
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-475-7000
Mailing Address - Street 1:1199 PRINCE AVENUE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-1426
Mailing Address - Country:US
Mailing Address - Phone:706-475-1920
Mailing Address - Fax:706-475-1921
Practice Address - Street 1:1199 PRINCE AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1426
Practice Address - Country:US
Practice Address - Phone:706-475-1920
Practice Address - Fax:706-475-1921
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIEDMONT ATHENS REG MED CTR, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-12
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0003603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003129999AMedicaid
2137167OtherPK
GA003129999AMedicaid