Provider Demographics
NPI: | 1295732600 |
---|---|
Name: | HYLER, PAUL J (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | PAUL |
Middle Name: | J |
Last Name: | HYLER |
Suffix: | |
Gender: | M |
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: | 201 HOSPITAL RD |
Mailing Address - Street 2: | |
Mailing Address - City: | CANTON |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30114-2408 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 770-720-5100 |
Mailing Address - Fax: | 404-851-6325 |
Practice Address - Street 1: | 450 NORTHSIDE CHEROKEE BLVD |
Practice Address - Street 2: | |
Practice Address - City: | CANTON |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30115-8015 |
Practice Address - Country: | US |
Practice Address - Phone: | 770-224-1000 |
Practice Address - Fax: | 770-224-2451 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-30 |
Last Update Date: | 2018-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 23629 | 207R00000X |
GA | 064567 | 208M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | 236293 | Medicaid | |
GA | 332488075A | Medicaid | |
SC | H80942 | Medicare UPIN | |
GA | 202I115843 | Medicare PIN | |
GA | 332488075A | Medicaid |