Healthcare Provider Details

I. General information

NPI: 1912975889
Provider Name (Legal Business Name): CYNTHIA L GILES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 11/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BLUEBIRD BLVD
FORT VALLEY GA
31030-5083
US

IV. Provider business mailing address

555 BLUEBIRD BLVD P. O. BOX 894
FORT VALLEY GA
31030-5083
US

V. Phone/Fax

Practice location:
  • Phone: 478-825-8954
  • Fax: 478-825-0281
Mailing address:
  • Phone: 478-825-8954
  • Fax: 478-825-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number048778
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: