Provider Demographics
NPI:1801878137
Name:KILZI, JOSEPH (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:KILZI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 161435
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30321-1435
Mailing Address - Country:US
Mailing Address - Phone:706-613-5880
Mailing Address - Fax:706-613-5883
Practice Address - Street 1:1500 OGLETHORPE AVE STE 500B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-613-5880
Practice Address - Fax:706-613-5883
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004061363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA263727746AMedicaid
GAF88353Medicare UPIN
GA97WCDRWMedicare PIN