Healthcare Provider Details

I. General information

NPI: 1558336073
Provider Name (Legal Business Name): TALLULAH HEALTH CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 TALLULAH RD
ROBBINSVILLE NC
28771-8500
US

IV. Provider business mailing address

409 TALLULAH RD
ROBBINSVILLE NC
28771-8500
US

V. Phone/Fax

Practice location:
  • Phone: 828-479-6434
  • Fax: 828-479-2917
Mailing address:
  • Phone: 828-479-6434
  • Fax: 828-479-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40397
License Number StateNC

VIII. Authorized Official

Name: PATRICIA J JOHNSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 828-479-6434