Provider Demographics
NPI:1467976811
Name:ANDERSON, TALIA MONTOYA (RN)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:MONTOYA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TALIA
Other - Middle Name:MONTOYA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:927 N HANSELL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4542
Mailing Address - Country:US
Mailing Address - Phone:229-289-2258
Mailing Address - Fax:229-213-5071
Practice Address - Street 1:927 N HANSELL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4542
Practice Address - Country:US
Practice Address - Phone:229-289-2258
Practice Address - Fax:229-213-5071
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN257947163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$Medicaid