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General NPI Number Information
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NPI Number | 1942303102
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Entity Type | Individual
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Provider Name | GEORGE PAUL TKALYCH MD PC
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 1900 10TH AVE SUITE 2901
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City | COLUMBUS
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State | GA
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Zip | 31901-3600
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Country | US
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Telephone | 706-596-1327
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Fax | 706-320-0789
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Provider Business Mailing Address
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Address Line | 1900 10TH AVE SUITE 201
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City | COLUMBUS
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State | GA
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Zip | 31901-3600
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Country | US
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Telephone | 706-596-1327
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Fax | 706-320-0789
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 022480
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License Number State | GA
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