# ATHENA MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164918124
- **Authorized official:** YANCEY SCOTT GAITHER CEO (MANAGING PARTNER)
- **Authorized official phone:** (480) 712-8319

## Contact information

- **Practice address:** 16515 S 40TH ST STE 143, PHOENIX, AZ 85048-0560
- **Practice address phone:** (480) 712-8319
- **Practice address fax:** (480) 712-1305
- **Mailing address:** 16515 S 40TH ST STE 143, PHOENIX, AZ 85048-0560
- **Mailing address phone:** (480) 712-8319
- **Mailing address fax:** (480) 712-1305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/02/2018
- **Last updated:** 01/20/2026