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RRC110074-00 PIEDMONT ATHENS REGIONAL MEDICAL CE (Active)
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Main Details
Name
PIEDMONT ATHENS REGIONAL MEDICAL CE
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC110074-00
Medicare Provider Number
110074
Additional Details
Current Program Status
Active
Registration Date
10/9/2024
Participating Start Date
12/4/2024
Participating Approval Date
10/21/2024
Last Recertification Date
Contacts
Authorizing Official
Piedmont Athens Regional
Justin Roberts, CFO
(706) 475-3463
Primary Contact
Piedmont Athens Regional
Don Wesley Tyson, Director of Pharmacy
(706) 475-4438
Addresses
Street Address
1199 PRINCE AVENUE
ATHENS, GA 30306
Billing Address
Piedmont Athens Regional Medical Center, Inc
1199 Prince Avenue
Basement
Athens, GA 30606
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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