Healthcare Provider Details

I. General information

NPI: 1194720896
Provider Name (Legal Business Name): DONNA K TALLON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PERRY HWY
HAWKINSVILLE GA
31036-6748
US

IV. Provider business mailing address

222 PERRY HWY
HAWKINSVILLE GA
31036-6748
US

V. Phone/Fax

Practice location:
  • Phone: 478-783-0299
  • Fax: 478-783-3730
Mailing address:
  • Phone: 478-934-0776
  • Fax: 478-934-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD000873
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: