Provider Demographics
NPI:1205919263
Name:AYLO HEALTH, LLC
Entity type:Organization
Organization Name:AYLO HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-914-0116
Mailing Address - Street 1:1502 HIGHWAY 16 E
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-5202
Mailing Address - Country:US
Mailing Address - Phone:678-774-0430
Mailing Address - Fax:770-775-3410
Practice Address - Street 1:1502 HIGHWAY 16 E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-5202
Practice Address - Country:US
Practice Address - Phone:678-774-0430
Practice Address - Fax:770-775-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACC6012OtherRAILROAD MEDICARE
GA061407OtherBC/BS OF GA GROUP
GAGRP1806Medicare ID - Type UnspecifiedMEDICARE