Provider Demographics
NPI:1942303102
Name:TKALYCH, GEORGE PAUL (MD PC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PAUL
Last Name:TKALYCH
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:P
Other - Last Name:TKALYCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:1900 10TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3600
Mailing Address - Country:US
Mailing Address - Phone:706-596-1327
Mailing Address - Fax:706-320-0789
Practice Address - Street 1:1900 10TH AVE
Practice Address - Street 2:SUITE 2901
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3600
Practice Address - Country:US
Practice Address - Phone:706-596-1327
Practice Address - Fax:706-320-0789
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022480207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00222329AMedicaid
GA00222329AMedicaid