Provider Demographics
NPI:1477558690
Name:TALLEY-HORNE, JILL R (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:TALLEY-HORNE
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 1:301 MED TECH PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2364
Mailing Address - Country:US
Mailing Address - Phone:423-794-1300
Mailing Address - Fax:423-794-1820
Practice Address - Street 1:301 MED TECH PKWY
Practice Address - Street 2:STE 200
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2364
Practice Address - Country:US
Practice Address - Phone:423-794-1300
Practice Address - Fax:423-794-1820
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26771207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3877371Medicaid
TN3877371Medicaid
TN3877371Medicare PIN