MEDICARE: TALIA GATES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	33373	AL

General Provider Information

NPI Number	:	1023337011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIA GATES M.D.

Provider Business Mailing Address
First Line	:	304 BLACKWELL DAIRY RD
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35504-8406
Country	:	US
Telephone Number	:	205-384-4801
Fax Number	:	205-384-4538

Provider Business Practice Location Address
First Line	:	304 BLACKWELL DAIRY RD
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35504-8406
Country	:	US
Telephone Number	:	205-384-4801
Fax Number	:	205-384-4538

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2010
Last Update Date	:	04/08/2020

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