Provider Demographics
NPI:1912975889
Name:GILES, CYNTHIA L (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:L
Last Name:GILES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BLUEBIRD BLVD
Mailing Address - Street 2:P. O. BOX 894
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-5083
Mailing Address - Country:US
Mailing Address - Phone:478-825-8954
Mailing Address - Fax:478-825-0281
Practice Address - Street 1:555 BLUEBIRD BLVD
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-5083
Practice Address - Country:US
Practice Address - Phone:478-825-8954
Practice Address - Fax:478-825-0281
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080182880OtherRAIL ROAD MEDICARE
GA00908729AMedicaid
GAH39689Medicare UPIN
GA00908729AMedicaid