EAST GEORGIA UROLOGIC CLINIC, PC
NPI 1801078381
Urology in Statesboro, GA
- Organization
- Urology
- CLIA Number: 11D1073777
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 07-22-2027
About EAST GEORGIA UROLOGIC CLINIC, PC
This page provides the complete NPI Profile along with additional information for East Georgia Urologic Clinic, Pc, a provider established in Statesboro, Georgia operating as a Urology. The healthcare provider is registered in the NPI registry with number 1801078381 assigned on November 2007. The practitioner's primary taxonomy code is 208800000X with license number 046818 (GA). The provider is registered as an organization and their NPI record was last updated 19 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Dr. Timothy R Thaller M.d. (President)
- NPI
- 1801078381 Verify this NPI
- Provider Name
- EAST GEORGIA UROLOGIC CLINIC, PC
- Entity Type
- Organization
- Location Address
- 614 E GRADY ST STATESBORO, GA 30458
- Location Phone
- (912) 764-9001
- Location Fax
- (912) 764-3166
- Mailing Address
- 614 EAST GRADY STREET STATESBORO, GA 30458
- Mailing Phone
- (912) 764-9001
- Mailing Fax
- (912) 764-3166
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-27-2007
- Last Update Date
- 01-03-2008
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Urology
- Taxonomy Code
- 208800000X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 046818
- License State
- GA
- Taxonomy Description
- A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 11D1073777
- Facility Type
- Physician Office
- Certificate Effective Date
- July 23, 2025
- Certificate Expiration Date
- July 22, 2027
- Laboratory Director
- DR. TIMOTHY THALLER
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to East Georgia Urologic Clinic, Pc in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1801078381, enumerated as an "organization" on November 27, 2007.
The provider is located at 614 E GRADY ST STATESBORO, GA 30458 and the phone number is (912) 764-9001.
Urology with taxonomy code 208800000X.
