Organization
EAST GEORGIA UROLOGIC CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY R THALLER M.D. (PRESIDENT)
(912) 764-9001
Entity
Organization
Contact information
Practice address
614 E GRADY ST, STATESBORO, GA 30458-2067
(912) 764-9001
(912) 764-3166
Mailing address
614 EAST GRADY STREET, STATESBORO, GA 30458
(912) 764-9001
(912) 764-3166
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
046818
GA
Other
Enumeration date
11/27/2007
Last updated
01/03/2008
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