Provider Demographics
NPI:1588937890
Name:ATHENS PEDIATRIC THERAPY SERVICES, INC
Entity type:Organization
Organization Name:ATHENS PEDIATRIC THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:706-202-0458
Mailing Address - Street 1:110 GREYSTONE TER
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-4460
Mailing Address - Country:US
Mailing Address - Phone:706-202-0458
Mailing Address - Fax:866-753-4652
Practice Address - Street 1:110 GREYSTONE TER
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-4460
Practice Address - Country:US
Practice Address - Phone:706-202-0458
Practice Address - Fax:866-753-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000900985BMedicaid