Provider Demographics
NPI:1598755803
Name:TILIAKOS, NICHOLAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:TILIAKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 490430
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0008
Mailing Address - Country:US
Mailing Address - Phone:678-985-4840
Mailing Address - Fax:678-985-4855
Practice Address - Street 1:705 WALTHER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8725
Practice Address - Country:US
Practice Address - Phone:770-963-3801
Practice Address - Fax:770-963-3856
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA022340207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00326367AMedicaid
GA00326367AMedicaid
GA$$$$$$$$$AMedicare PIN