Healthcare Provider Details

I. General information

NPI: 1205779287
Provider Name (Legal Business Name): TALIA A MCCOOL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BLOWERS BLVD
ELIZABETHTON TN
37682
US

IV. Provider business mailing address

1 BLOWERS BLVD
MILLIGAN COLLEGE TN
37682
US

V. Phone/Fax

Practice location:
  • Phone: 423-461-8700
  • Fax:
Mailing address:
  • Phone: 770-605-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: