Provider Demographics
NPI:1558336073
Name:TALLULAH HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:TALLULAH HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-479-6434
Mailing Address - Street 1:409 TALLULAH RD
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771-8500
Mailing Address - Country:US
Mailing Address - Phone:828-479-6434
Mailing Address - Fax:828-479-2917
Practice Address - Street 1:409 TALLULAH RD
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-8500
Practice Address - Country:US
Practice Address - Phone:828-479-6434
Practice Address - Fax:828-479-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02762OtherBLUE CROSS PRACTICE NUMBR
NC7902762Medicaid
NC0891Medicare ID - Type UnspecifiedPRACTICE NUMBER