Provider Demographics
NPI:1649337510
Name:ATHENS PULMONARY AND ALLERGY, P.C.
Entity type:Organization
Organization Name:ATHENS PULMONARY AND ALLERGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:MIDDENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-549-5560
Mailing Address - Street 1:3320 OLD JEFFERSON RD
Mailing Address - Street 2:BLDG 200 SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-549-5560
Mailing Address - Fax:706-549-5828
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:BLDG 200 SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-549-5560
Practice Address - Fax:706-549-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP652Medicare ID - Type Unspecified