Healthcare Provider Details

I. General information

NPI: 1912001421
Provider Name (Legal Business Name): THOMAS CARTER TALLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 5TH AVE
ALBANY GA
31701-1918
US

IV. Provider business mailing address

414 5TH AVE
ALBANY GA
31701-1918
US

V. Phone/Fax

Practice location:
  • Phone: 229-883-4555
  • Fax: 229-888-0063
Mailing address:
  • Phone: 229-883-4555
  • Fax: 229-888-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number033895
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: