Provider Demographics
NPI:1790997658
Name:PIEDMONT UROLOGY, P.C.
Entity Type:Organization
Organization Name:PIEDMONT UROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCALJON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-352-9260
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:SUITE 6025
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1796
Mailing Address - Country:US
Mailing Address - Phone:404-352-9260
Mailing Address - Fax:404-352-9187
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:SUITE 6025
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1796
Practice Address - Country:US
Practice Address - Phone:404-352-9260
Practice Address - Fax:404-352-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2307Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER