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I thereby give permission for Rheumatology Center of Athens owned and operated by St. Mary s Medical Group Inc. a subsidiary of ST. Rheumatology Center of Athens 1622 C Mars Hill Road Watkinsville GA 30677 Phone 706-769-9931 Fax 706-310-0499 Please Fill Out Completely Patient s Last Name Social Security Number First Name Date of Birth Age Gender Race MI Marital Status Ethnicity Latino Address Street Route Apt. I request payment of authorized Medicare benefits for me or on my behalf for any...
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The rheumatology center of aformns is a specialized medical facility that focuses on the diagnosis and treatment of rheumatic diseases.
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