East Georgia Urologic Clinic, PC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

046818 Issued in GA

Legal business name

EAST GEORGIA UROLOGIC CLINIC, PC

Practice address

614 E Grady St
Statesboro, GA 30458-2067

Phone

(912) 764-9001

Fax

(912) 764-3166

NPI assigned

Nov 27, 2007

Last updated

Jan 3, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Timothy R Thaller, M.D.NPI 1407849706

Title

President

Phone

(912) 764-9001

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy R Thaller, MD

  • Urology Physician
  • Statesboro, GA
  • NPI 1407849706
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1801078381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "614 EAST GRADY STREET",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "30458",
            "telephone_number": "912-764-9001",
            "fax_number": "912-764-3166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "614 E GRADY ST",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304582067",
            "telephone_number": "912-764-9001",
            "fax_number": "912-764-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GEORGIA UROLOGIC CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "THALLER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-764-9001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "046818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Georgia Radiology LLC
• East Georgia Regional Medical Center, LLC
• East Georgia Regional Medical Center, LLC (Statesboro Imaging Center)
• East Georgia Regional Medical Center, LLC
• East Georgia Urgent Care
• East Georgia Womens Center
• Hillary J Edenfield, LAPC
• Natosha Edenfield, LPC
• Rachel Oglesby Edenfield, PNP
• James Harvey Elerson Jr., DMD

• Urology Physician in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Urology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.