Provider Demographics
NPI:1467658393
Name:TALIAFERRO, SUMAYAH JAMILA (MD)
Entity Type:Individual
Prefix:
First Name:SUMAYAH
Middle Name:JAMILA
Last Name:TALIAFERRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52226
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-0226
Mailing Address - Country:US
Mailing Address - Phone:404-816-7900
Mailing Address - Fax:404-816-7929
Practice Address - Street 1:3131 MAPLE DR NE
Practice Address - Street 2:SUITE 102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2515
Practice Address - Country:US
Practice Address - Phone:404-816-7900
Practice Address - Fax:404-816-7929
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059337174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
059337OtherSTATE LICENSE