# PIEDMONT ATHENS PRIMARY CARE LLC

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

## Provider details

- **NPI number:** 1245746783
- **Authorized official:** MRS. CHRISTY AQUINO (DIRECTOR OF PROVIDER ENROLLMENT)
- **Authorized official phone:** (470) 271-3427

## Contact information

- **Practice address:** 1199 PRINCE AVE, ATHENS, GA 30606-2797
- **Practice address phone:** (706) 369-5440
- **Practice address fax:** (706) 369-5490
- **Mailing address:** PO BOX 117264, ATLANTA, GA 30368-7264
- **Mailing address phone:** (770) 801-2500

## Taxonomy

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

## Other

- **Enumeration date:** 12/20/2017
- **Last updated:** 08/11/2021