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General NPI Number Information
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NPI Number | 1659321107
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Entity Type | Individual
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Provider Name | JOE TALTSON SOUTHERLAND DPM
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 49 GORDON RD SUITE 104
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City | JASPER
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State | GA
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Zip | 30143
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Country | US
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Telephone | 770-999-0804
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Fax | 770-999-0814
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Provider Business Mailing Address
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Address Line | 400 W ARBROOK BLVD SUITE 201
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City | ARLINGTON
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State | TX
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Zip | 76014-3174
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Country | US
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Telephone | 817-467-1990
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Fax | 817-466-8737
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1473
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD000709
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License Number State | GA
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