Provider Demographics
NPI:1679584072
Name:NATER TZILIANOS, CYNTHIA A (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:NATER TZILIANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 HIGHWAY 54 WEST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4552
Mailing Address - Country:US
Mailing Address - Phone:770-991-2200
Mailing Address - Fax:770-991-1341
Practice Address - Street 1:1279 HIGHWAY 54 W
Practice Address - Street 2:SUITE 220
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4552
Practice Address - Country:US
Practice Address - Phone:770-991-2200
Practice Address - Fax:770-991-1341
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA501518174AMedicaid
GAI40028Medicare UPIN
GA16BBCVWMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NO