Provider Demographics
NPI:1881757193
Name:ATHEN KIDS SPECIALISTS P.C
Entity type:Organization
Organization Name:ATHEN KIDS SPECIALISTS P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-543-9899
Mailing Address - Street 1:650 OGLETHORPE AVE.
Mailing Address - Street 2:STE 4
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2216
Mailing Address - Country:US
Mailing Address - Phone:706-543-9899
Mailing Address - Fax:956-283-1889
Practice Address - Street 1:650 OGLETHORPE AVE.
Practice Address - Street 2:STE 4
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30303-2216
Practice Address - Country:US
Practice Address - Phone:706-543-9899
Practice Address - Fax:956-283-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA197380OtherBC BS OF GA
GA341305OtherWELLCARE
GA8668423278OtherUNITED HEALTH CARE
GA10056366OtherAMERIGROUP
GA=========OtherTAX ID #
GA197380OtherBC BS OF GA