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DSH110074B PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC (Terminated)
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Main Details
Name
PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC
Subdivision Name
PIEDMONT ATHENS REGIONAL MEDICAL CENTER INC / Out Patient Surgery Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110074B
Medicare Provider Number
110074
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/4/2015
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
1295 PRINCE AVENUE
ATHENS, GA 30606-2797
Billing Address
Piedmont Athens Regional Medical Center, Inc
1199 Prince Avenue
Athens, GA 30606
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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