Provider Demographics
NPI:1811399090
Name:ATHENS MODEL NEIGHBORHOOD HEALTH CENTER INC
Entity type:Organization
Organization Name:ATHENS MODEL NEIGHBORHOOD HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-543-1145
Mailing Address - Street 1:402 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-3261
Mailing Address - Country:US
Mailing Address - Phone:706-543-1145
Mailing Address - Fax:706-549-0056
Practice Address - Street 1:402 MCKINLEY DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-3261
Practice Address - Country:US
Practice Address - Phone:706-850-8057
Practice Address - Fax:706-549-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336S0011X, 333600000X
GAPHRE0101273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151280OtherPK