Provider Demographics
NPI:1740471630
Name:UROLOGY OF ATHENS, P.A.
Entity type:Organization
Organization Name:UROLOGY OF ATHENS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-543-3429
Mailing Address - Street 1:195 KING AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2963
Mailing Address - Country:US
Mailing Address - Phone:706-543-3429
Mailing Address - Fax:706-353-7127
Practice Address - Street 1:195 KING AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2963
Practice Address - Country:US
Practice Address - Phone:706-543-3429
Practice Address - Fax:706-353-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19165208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE00408Medicare UPIN