Provider Demographics
NPI:1558497123
Name:TALBOT, JAMES EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:TALBOT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 RIVER TERRACE
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540
Mailing Address - Country:US
Mailing Address - Phone:706-635-5878
Mailing Address - Fax:706-635-5879
Practice Address - Street 1:3509 BAKER RD NW STE 401
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6305
Practice Address - Country:US
Practice Address - Phone:770-917-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011299122300000X
GA011299122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000682987AMedicaid