1689977761 NPI number — ATHENS SLEEP AND WELLNESS CENTER

Table of content: (NPI 1689977761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689977761 NPI number — ATHENS SLEEP AND WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHENS SLEEP AND WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689977761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2005 PRINCE AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30606-6032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-208-9700
Provider Business Mailing Address Fax Number:
706-208-0806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1490 PRINCE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-2210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-613-6990
Provider Business Practice Location Address Fax Number:
706-613-6989
Provider Enumeration Date:
12/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AGRAWAL
Authorized Official First Name:
SUBODH
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
706-613-6990

Provider Taxonomy Codes

  • Taxonomy code: 207RS0012X , with the licence number:  028344 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QS1200X , with the licence number: 028344 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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