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DSH110074 PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC (Terminated)
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Main Details
Name
PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110074
Medicare Provider Number
110074
Additional Details
Current Program Status
Terminated
Registration Date
9/29/2005
Participating Start Date
9/29/2005
Participating Approval Date
9/29/2005
Last Recertification Date
8/26/2024
Termination Date
Termination Reason
1/1/2025
Change of covered entity type
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 30606
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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May 2025
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