Provider Demographics
NPI:1053962902
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:HUMAN RESOURCE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:762-499-6960
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30603-0147
Mailing Address - Country:US
Mailing Address - Phone:762-499-6960
Mailing Address - Fax:706-850-9047
Practice Address - Street 1:870 GAINES SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3132
Practice Address - Country:US
Practice Address - Phone:762-499-6960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLSMAN HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-23
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)