Provider Demographics
NPI:1558125369
Name:TALLEY, ROBBY (NP)
Entity Type:Individual
Prefix:
First Name:ROBBY
Middle Name:
Last Name:TALLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 GLEN KAREN DR
Mailing Address - Street 2:
Mailing Address - City:DILLARD
Mailing Address - State:GA
Mailing Address - Zip Code:30537-1711
Mailing Address - Country:US
Mailing Address - Phone:706-244-9899
Mailing Address - Fax:
Practice Address - Street 1:1499 FAIR RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1683
Practice Address - Country:US
Practice Address - Phone:912-468-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN283195363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner