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General NPI Number Information
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NPI Number | 1053652271
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Entity Type | Individual
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Provider Name | TALLEY S SOFIANOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 8832 US HIGHWAY 90
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City | DAPHNE
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State | AL
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Zip | 36526-8932
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Country | US
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Telephone | 251-289-1786
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Fax |
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Provider Business Mailing Address
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Address Line | 14557 HIGHWAY 19 STE A
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City | GRIFFIN
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State | GA
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Zip | 30224-9582
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Country | US
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Telephone | 678-688-1580
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Fax | 678-688-1594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 006755
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License Number State | GA
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