Provider Demographics
NPI:1114359916
Name:PAUL JOSEPH GILES, M.D., LLC
Entity Type:Organization
Organization Name:PAUL JOSEPH GILES, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-537-8691
Mailing Address - Street 1:1006 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-3029
Mailing Address - Country:US
Mailing Address - Phone:912-537-1221
Mailing Address - Fax:912-537-1012
Practice Address - Street 1:1006 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-3029
Practice Address - Country:US
Practice Address - Phone:912-537-1221
Practice Address - Fax:912-537-1012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST PRIMARY CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39950Medicare UPIN