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General NPI Number Information
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NPI Number | 1568553196
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Entity Type | Individual
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Provider Name | TALMADGE LAMONT CHRISTIAN CSA
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 06/17/2015
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Provider Practice Location Address
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Address Line | 4426 HUGH HOWELL RD SUITE B-158
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City | TUCKER
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State | GA
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Zip | 30084-4918
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Country | US
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Telephone | 678-642-4736
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Fax | 770-938-2017
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Provider Business Mailing Address
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Address Line | 4426 HUGH HOWELL RD SUITE B-158
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City | TUCKER
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State | GA
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Zip | 30084-4918
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Country | US
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Telephone | 678-642-4736
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Fax | 770-938-2017
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 2670
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License Number State | GA
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