Provider Demographics
NPI:1265690127
Name:THE UROLOGY CLINIC
Entity Type:Organization
Organization Name:THE UROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLS
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:706-543-2718
Mailing Address - Street 1:868 MICHAEL ETCHISON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8204
Mailing Address - Country:US
Mailing Address - Phone:706-543-2718
Mailing Address - Fax:706-353-3709
Practice Address - Street 1:120 TRINITY PL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-2100
Practice Address - Country:US
Practice Address - Phone:706-543-2718
Practice Address - Fax:706-353-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP814OtherMEDICARE