Provider Demographics
NPI:1194188516
Name:TALLMAN, JODI (NP)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:TALLMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 THOMASTON ST
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:GA
Mailing Address - Zip Code:30295-3397
Mailing Address - Country:US
Mailing Address - Phone:470-980-7520
Mailing Address - Fax:866-596-4671
Practice Address - Street 1:623 THOMASTON ST
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:GA
Practice Address - Zip Code:30295-3397
Practice Address - Country:US
Practice Address - Phone:470-980-7520
Practice Address - Fax:866-596-4671
Is Sole Proprietor?:No
Enumeration Date:2016-04-02
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily