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General NPI Number Information
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NPI Number | 1619399664
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Entity Type | Organization
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Legal Business Name | NICHOLAS A TILIAKOS MD
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 705 WALTHER RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8725
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Country | US
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Telephone | 770-963-3801
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Fax | 770-963-3856
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Provider Business Mailing Address
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Address Line | 705 WALTHER RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8725
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Country | US
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Telephone | 770-963-3801
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Fax | 770-963-3856
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS A TILIAKOS
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Credential | MD
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Telephone | 770-963-3801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 022340
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License Number State | GA
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