Healthcare Provider Details

I. General information

NPI: 1396219390
Provider Name (Legal Business Name): ROSETTA DERRICK TALBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 WRIGHTSBORO RD
AUGUSTA GA
30904-4887
US

IV. Provider business mailing address

3614 TWO NOTCH RD
LEXINGTON SC
29072-7607
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-4400
  • Fax: 706-724-6003
Mailing address:
  • Phone: 803-260-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN241900
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: