Athens Immediate Care #1, LLC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

Legal business name

ATHENS IMMEDIATE CARE #1, LLC

Doing business as

smartERclinix of Athens #1

Practice address

1010 Prince Ave
South Building
Athens, GA 30606-5805

Phone

(706) 850-8200

Fax

(706) 850-8250

NPI assigned

Jul 23, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Wildmon

Title

Executive Vice President

Phone

(678) 471-5308

Specialties & licenses 1

Addresses

Other names 1

• smartERclinix of Athens #1 Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279843200000",
    "number": "1174836753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 PRINCE AVE",
            "address_2": "SOUTH BUILDING",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306065805",
            "telephone_number": "706-850-8200",
            "fax_number": "706-850-8250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 PRINCE AVE",
            "address_2": "SOUTH BUILDING",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306065805",
            "telephone_number": "706-850-8200",
            "fax_number": "706-850-8250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENS IMMEDIATE CARE #1, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-23",
        "last_updated": "2010-07-23",
        "status": "A",
        "authorized_official_last_name": "WILDMON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "678-471-5308",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "smartERclinix of Athens #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Acute Care Nurse Practitioner in Athens, GA
• Providers in Athens, GA by specialty
• Acute Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.