Doctor Name: | MRS. JODI TALLMAN |
NPI Number: | 1194188516 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | RN170855 |
Business Practice Address: | 101 Deluxe Cir Ste B Thomaston, GA - 302863030 |
Business Phone Number: | 7066477509 |
Business Fax Number: | 7066476624 |
Mailing Address: | 101 Deluxe Cir Ste B, THOMASTON |
State: | GA |
Postal Code: | 302863030 |
Phone Number: | 7066477509 |
Fax Number: | 7066476624 |
NPI Enumeration Date: | 04/02/2016 |
NPI Last Update Date: | 05/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN170855 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |