Active NPI
Athena T Jolly, M.D.
- Occupational Medicine Physician
- Williamsport, PA
National Provider Identifier
1649324930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- License
- MD043019E
- Practice address
- 1100 Grampian Blvd
Williamsport, PA 17701-1909 - Phone
- (570) 320-7444
- Fax
- (570) 320-7445
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | C1-0000709 | DE | |
| Occupational Medicine Physician | 2083X0100X | MD043019E | PA | Primary |
| Internal Medicine Physician | 207R00000X | MD043019E | PA |
Addresses
Primary practice location
1100 Grampian Blvd
Williamsport, PA 17701-1909
Mailing address
1201 Grampian Blvd
Suite 1K
Williamsport, PA 17701-1900
Phone (570) 326-8723
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C1-0000709 | Other | DE | PROFESSIONAL LICENSE |
| 1000030188 | Medicaid | DE | |
| MD043019E | Other | PA | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480896000000",
"number": "1649324930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 GRAMPIAN BLVD",
"address_2": "SUITE 1K",
"city": "WILLIAMSPORT",
"state": "PA",
"postal_code": "177011900",
"telephone_number": "570-326-8723",
"fax_number": "570-326-8922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 GRAMPIAN BLVD",
"city": "WILLIAMSPORT",
"state": "PA",
"postal_code": "177011909",
"telephone_number": "570-320-7444",
"fax_number": "570-320-7445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOLLY",
"first_name": "ATHENA",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2016-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "DE",
"license": "C1-0000709",
"primary": false
},
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "PA",
"license": "MD043019E",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MD043019E",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE",
"identifier": "C1-0000709",
"state": "DE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1000030188",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "MD043019E",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Williamsport, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.