Organization
PIEDMONT ATHENS PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTY AQUINO (DIRECTOR OF PROVIDER ENROLLMENT)
(470) 271-3427
Entity
Organization
Contact information
Practice address
1199 PRINCE AVE, ATHENS, GA 30606-2797
(706) 369-5440
(706) 369-5490
Mailing address
PO BOX 117264, ATLANTA, GA 30368-7264
(770) 801-2500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003208591A
—
GA
Enumeration date
12/20/2017
Last updated
08/11/2021
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