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General NPI Number Information
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NPI Number | 1558125369
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Entity Type | Individual
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Provider Name | ROBBY TALLEY NP
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Gender | Male
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 1499 FAIR RD
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City | STATESBORO
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State | GA
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Zip | 30458-1683
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Country | US
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Telephone | 912-468-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 145 GLEN KAREN DR
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City | DILLARD
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State | GA
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Zip | 30537-1711
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Country | US
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Telephone | 706-244-9899
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN283195
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | RN283195
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN-NP283195
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License Number State | GA
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