Jolly, Athena T
Jolly, Athena T is an individual health care provider with primary practice located at 1100 Grampian Blvd , Williamsport PA 17701-1909. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Occupational Medicine. Allopathic & Osteopathic Physicians / Occupational Medicine is her primary health care specialty. Jolly, Athena T can be contacted via phone (570) 320-7444.Contact Information
Primary practice address
1100 Grampian Blvd
Williamsport PA 17701-1909
Phone: (570) 320-7444
Fax: (570) 320-7445
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | C1-0000709 | Delaware |
| Allopathic & Osteopathic Physicians / Occupational Medicine | 2083X0100X | MD043019E | Pennsylvania |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD043019E | Pennsylvania |
Profile Details
| NPI number | 1649324930 |
|---|---|
| LBN Legal business name | Jolly, Athena T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 23rd, 2007 |
| Last updated | Dec 5th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649324930 | NPPES |
| Delaware | Other | C1-0000709 | PROFESSIONAL LICENSE |
| Delaware | MEDICAID | 1000030188 | PROFESSIONAL LICENSE |
| Delaware | Other | MD043019E | PROFESSIONAL LICENSE |
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