Healthcare Provider Details

I. General information

NPI: 1881673739
Provider Name (Legal Business Name): TODD M TALMADGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 NASHVILLE ST
RUSSELLVILLE KY
42276-8853
US

IV. Provider business mailing address

PO BOX 3339
CLARKSVILLE TN
37043-3339
US

V. Phone/Fax

Practice location:
  • Phone: 270-725-4561
  • Fax:
Mailing address:
  • Phone: 931-647-5034
  • Fax: 931-552-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD36221
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: