Provider Demographics
NPI:1265642789
Name:TALMADGE, WILLIAM TRACY (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TRACY
Last Name:TALMADGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LENOX POINTE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3169
Mailing Address - Country:US
Mailing Address - Phone:404-846-9796
Mailing Address - Fax:404-264-0743
Practice Address - Street 1:34 LENOX POINTE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3169
Practice Address - Country:US
Practice Address - Phone:404-846-9796
Practice Address - Fax:404-264-0743
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2705103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist