Provider Demographics
NPI:1336365931
Name:ATHENS AREA INTERNAL MEDICINE
Entity type:Organization
Organization Name:ATHENS AREA INTERNAL MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SORRELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-546-0832
Mailing Address - Street 1:1000 HAWTHORNE AVE STE H
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2168
Mailing Address - Country:US
Mailing Address - Phone:706-546-0832
Mailing Address - Fax:706-369-5068
Practice Address - Street 1:1000 HAWTHORNE AVE STE H
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2168
Practice Address - Country:US
Practice Address - Phone:706-546-0832
Practice Address - Fax:706-369-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty