MEDICARE: CYNTHIA L. GILES, D.O., L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN173610 NP	GA
2	207Q00000X	Family Medicine Physician	048778	GA

General Provider Information

NPI Number	:	1801159777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA L. GILES, D.O., L.L.C.

Provider Business Mailing Address
First Line	:	555 BLUEBIRD BLVD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-5083
Country	:	US
Telephone Number	:	478-825-8954
Fax Number	:	478-825-0281

Provider Business Practice Location Address
First Line	:	555 BLUEBIRD BLVD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-5083
Country	:	US
Telephone Number	:	478-825-8954
Fax Number	:	478-825-0281

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CYNTHIA L GILES
Credential	:	D.O.
Telephone Number	:	478-825-8954

Provider Enumeration Date	:	06/16/2012
Last Update Date	:	06/16/2012

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