Provider Demographics
NPI:1336408608
Name:GEORGE P. TKALYCH, M.D. P.C.
Entity Type:Organization
Organization Name:GEORGE P. TKALYCH, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TKALYCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:706-546-1327
Mailing Address - Street 1:1900 10TH AVENUE
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 AVENUE
Practice Address - Street 2:SUITE 201
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:706-546-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022480207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100222329AMedicaid
GAC78669Medicare UPIN