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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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