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General NPI Number Information
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NPI Number | 1083666739
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Entity Type | Individual
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Provider Name | GREGORY BENTON TALLEY D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 1544 PIEDMONT AVE NE STE 109
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City | ATLANTA
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State | GA
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Zip | 30324-5018
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Country | US
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Telephone | 404-892-8191
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Fax |
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Provider Business Mailing Address
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Address Line | 1544 PIEDMONT AVE NE STE 109
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City | ATLANTA
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State | GA
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Zip | 30324-5018
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Country | US
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Telephone | 404-892-8191
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Fax | 404-892-8197
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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 | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | GA2913
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | 2913
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License Number State | GA
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