MEDICARE: DR. GEORGE PAUL TKALYCH MD PC

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	207Y00000X	Otolaryngology Physician	022480	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942303102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE PAUL TKALYCH MD PC

Provider Business Mailing Address
First Line	:	1900 10TH AVE
Second Line	:	SUITE 201
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3600
Country	:	US
Telephone Number	:	706-596-1327
Fax Number	:	706-320-0789

Provider Business Practice Location Address
First Line	:	1900 10TH AVE
Second Line	:	SUITE 2901
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3600
Country	:	US
Telephone Number	:	706-596-1327
Fax Number	:	706-320-0789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	04/23/2012

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