| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 240 North Ave, Athens, Georgia |
| Authorized Official Name and Position | Justin Grant Gillespie (CHAIRMAN OF THE BOARD) |
| Authorized Official Contact | 7065493730 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
240 North Ave Athens GA 30601-2244 Ph: (706) 549-3730 | 240 North Ave Athens GA 30601-2244 Ph: (706) 549-3730 |
| NPI Number | 1790276210 |
|---|---|
| Provider Enumeration Date | 05/21/2018 |
| Last Update Date | 05/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790276210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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