Individual
THADDEUS H RILEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
23702 HWY 80 E, STATESBORO, GA 30458
(912) 489-4090
(912) 765-5028
Mailing address
23702 HWY 80 E, PO BOX 957, STATESBORO, GA 30459
(912) 489-4090
(912) 765-5028
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
028637
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00351601C
—
GA
Enumeration date
05/04/2006
Last updated
10/27/2020
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