Provider Demographics
NPI:1447856901
Name:LILLY, GEORGE ARTHUR SR
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ARTHUR
Last Name:LILLY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1809
Mailing Address - Country:US
Mailing Address - Phone:229-255-4558
Mailing Address - Fax:229-405-3507
Practice Address - Street 1:1503 STUART AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1809
Practice Address - Country:US
Practice Address - Phone:229-255-4558
Practice Address - Fax:229-405-3507
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA057883195OtherDRIVERS LICENSE NUMBER