Healthcare Provider Details

I. General information

NPI: 1831106988
Provider Name (Legal Business Name): LEONARD MICHAEL TALARICO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/12/2022
Certification Date: 02/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 TRADERS WAY
POOLER GA
31322-4035
US

IV. Provider business mailing address

140 TRADERS WAY
POOLER GA
31322-4035
US

V. Phone/Fax

Practice location:
  • Phone: 912-330-8885
  • Fax: 912-330-8858
Mailing address:
  • Phone: 912-330-8885
  • Fax: 912-330-8858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number945
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number945
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: