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DSH110074K 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 Community Care Clinic - Piedmont Athens Regional Community Care Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110074K
Medicare Provider Number
110074
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/1/2019
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
1270 Prince Ave.
201
Athens, GA 30606
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
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May 2025
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