Provider Demographics
NPI:1982602801
Name:ATHEY, GEORGE R (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:ATHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 ELKTON DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8507
Mailing Address - Country:US
Mailing Address - Phone:719-268-6992
Mailing Address - Fax:719-570-0386
Practice Address - Street 1:1115 ELKTON DR
Practice Address - Street 2:SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8507
Practice Address - Country:US
Practice Address - Phone:719-268-6992
Practice Address - Fax:719-570-0386
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO404692084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77687736Medicaid
804755Medicare PIN
F27359Medicare UPIN