Riley, Thaddeus H
Riley, Thaddeus H is an individual health care provider with primary practice located at 23702 Hwy 80 E , Statesboro GA 30458. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Riley, Thaddeus H can be contacted via phone (912) 489-4090.Contact Information
Primary practice address
23702 Hwy 80 E
Statesboro GA 30458
Phone: (912) 489-4090
Fax: (912) 765-5028
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 028637 | Georgia |
Profile Details
| NPI number | 1104874031 |
|---|---|
| LBN Legal business name | Riley, Thaddeus H |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 4th, 2006 |
| Last updated | Oct 27th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104874031 | NPPES |
| Georgia | MEDICAID | 00351601C |
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