MEDICARE: AYLO HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC6012	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	061407	OTHER	GA	BC/BS OF GA GROUP

General Provider Information

NPI Number	:	1205919263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AYLO HEALTH, LLC

Provider Business Mailing Address
First Line	:	1502 HIGHWAY 16 E
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-5202
Country	:	US
Telephone Number	:	678-774-0430
Fax Number	:	770-775-3410

Provider Business Practice Location Address
First Line	:	1502 W 3RD ST STE A
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-1979
Country	:	US
Telephone Number	:	678-774-0430
Fax Number	:	770-775-3410

Authorized Official
Title or Position	:	CEO
Name	:	NICHOLAS WILLIAMS
Credential	:
Telephone Number	:	770-914-0116

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/28/2025

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Directions to “AYLO HEALTH, LLC ” Practice Location

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