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General NPI Number Information
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NPI Number | 1043159189
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Entity Type | Organization
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Legal Business Name | TALLAH MEDICAL AR PLLC
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 201 SW 14TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-7449
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Country | US
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Telephone | 479-785-2229
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Fax | 479-314-3185
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 479-785-2229
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLARISSE TALLAH
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Credential |
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Telephone | 479-785-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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