| Timothy R Thaller, MD | |
|
614 E Grady St, Statesboro, GA 30458-2067 | |
| (912) 764-9001 | |
| (912) 764-3166 |
| Full Name | Timothy R Thaller |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Experience | 31 Years |
| Location | 614 E Grady St, Statesboro, Georgia |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407849706 | NPI | - | NPPES |
| 000829507B | Medicaid | GA | |
| 340016471 | Other | GA | RR MEDICARE |
| 782637 | Other | GA | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 046818 (Georgia) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| East Georgia Regional Medical Center | Statesboro, GA | Hospital |
| Evans Memorial Hospital | Claxton, GA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| East Georgia Hma Physician Management Llc | 7214068592 | 35 |
| Entity Name | East Georgia Urologic Clinic, Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1801078381 PECOS PAC ID: 5698865863 Enrollment ID: O20071212000494 |
| Entity Name | East Georgia Hma Physician Management Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1487983151 PECOS PAC ID: 7214068592 Enrollment ID: O20100630000504 |
| Mailing Address | Practice Location Address |
|---|---|
| Timothy R Thaller, MD 614 E Grady St, Statesboro, GA 30458-2067 Ph: (912) 764-9001 | Timothy R Thaller, MD 614 E Grady St, Statesboro, GA 30458-2067 Ph: (912) 764-9001 |
Thomas A. Sorbera, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 1497 Fair Rd Ste 102, Statesboro, GA 30458 Phone: 912-764-9001 Fax: 912-764-3166 | |
Paul J Tilson, MD Urology Medicare: Not Enrolled in Medicare Practice Location: 412 Northside Dr E, #500, Statesboro, GA 30458 Phone: 912-764-6808 Fax: 912-764-2436 |