MEDICARE: DR. MALISSA GOBBELL TALBERT 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	20014	TN
2	207RR0500X	Rheumatology Physician	20014	TN

General Provider Information

NPI Number	:	1497957914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALISSA GOBBELL TALBERT M.D.

Provider Business Mailing Address
First Line	:	1100 E 3RD ST
Second Line	:	UTFP
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2241
Country	:	US
Telephone Number	:	423-778-8837
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 E 3RD ST
Second Line	:	UTFP
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-2241
Country	:	US
Telephone Number	:	423-778-8837
Fax Number	:

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	10/06/2008

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