Organization
STATESBORO UROLOGIC CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL J TILSON MD (PRESIDENT)
(912) 764-6808
Entity
Organization
Contact information
Practice address
412 NORTHSIDE DR E, SUITE 500, STATESBORO, GA 30458-4802
(912) 764-6808
(912) 764-2436
Mailing address
412 NORTHSIDE DR E, SUITE 500, STATESBORO, GA 30458-4802
(912) 764-6808
(912) 764-2436
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
020839
GA
208800000X
Urology Physician
046818
GA
Other
Enumeration date
06/30/2006
Last updated
08/22/2020
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