Provider Demographics
NPI:1417261736
Name:TALTON PHYSICIAN SERVICES PLLC
Entity Type:Organization
Organization Name:TALTON PHYSICIAN SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:TALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-222-5908
Mailing Address - Street 1:201 CREST DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-2619
Mailing Address - Country:US
Mailing Address - Phone:919-222-5908
Mailing Address - Fax:
Practice Address - Street 1:201 CREST DR
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-2619
Practice Address - Country:US
Practice Address - Phone:919-222-5908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801525207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty