Provider Demographics
NPI:1215436043
Name:ATHENS OBSTETRICS AND GYNECOLOGY, LLC
Entity type:Organization
Organization Name:ATHENS OBSTETRICS AND GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-891-6541
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:740 PRINCE AVE STE 3
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5903
Practice Address - Country:US
Practice Address - Phone:706-548-4272
Practice Address - Fax:706-548-9181
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTA WOMEN'S HEALTH GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3569OtherPTAN
GA300034164AMedicaid