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Organization

ATHENS MEDICAL GROUP LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. TERRANCE E WILSON (CEO)
(765) 423-6161
Entity
Organization

Contact information

Practice address
1660 LAFAYETTE RD, CRAWFORDSVILLE, IN 47933-4601
(765) 364-5360
(765) 359-2233
Mailing address
1660 LAFAYETTE RD, CRAWFORDSVILLE, IN 47933-4601
(765) 364-5360
(765) 359-2233

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207R00000X
Internal Medicine Physician
207V00000X
Obstetrics & Gynecology Physician
207X00000X
Orthopaedic Surgery Physician
207Y00000X
Otolaryngology Physician
208600000X
Surgery Physician

Other

Enumeration date
05/11/2009
Last updated
05/11/2009
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