Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 032219 | GA |
NPI | 1013981968 |
---|---|
Provider Name | Edward Wylly Killorin JR. |
First Address | Columbus, GA 31901 |
Second Address | Columbus, GA 31901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 25/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005420778 | (05) | GA |
F53642 | (02) |