Healthcare Provider Details

I. General information

NPI: 1801878137
Provider Name (Legal Business Name): JOSEPH KILZI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OGLETHORPE AVE STE 500B
ATHENS GA
30606
US

IV. Provider business mailing address

PO BOX 161435
ATLANTA GA
30321-1435
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-5880
  • Fax: 706-613-5883
Mailing address:
  • Phone: 706-613-5880
  • Fax: 706-613-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number004061
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: