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General NPI Number Information
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NPI Number | 1801159777
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Entity Type | Organization
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Legal Business Name | CYNTHIA L. GILES, D.O., L.L.C.
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Dates
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Enumeration Date | 06/16/2012
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Last Update Date | 06/16/2012
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Provider Practice Location Address
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Address Line | 555 BLUEBIRD BLVD
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City | FORT VALLEY
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State | GA
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Zip | 31030-5083
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Country | US
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Telephone | 478-825-8954
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Fax | 478-825-0281
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Provider Business Mailing Address
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Address Line | 555 BLUEBIRD BLVD
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City | FORT VALLEY
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State | GA
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Zip | 31030-5083
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Country | US
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Telephone | 478-825-8954
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Fax | 478-825-0281
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Authorized Official
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Title or Position | OWNER
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Name | DR. CYNTHIA L GILES
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Credential | D.O.
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Telephone | 478-825-8954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN173610 NP
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 048778
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License Number State | GA
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