Provider Demographics
NPI:1790317808
Name:TALLANT, NANCY BARRETT
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BARRETT
Last Name:TALLANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2305
Mailing Address - Country:US
Mailing Address - Phone:770-920-1884
Mailing Address - Fax:770-920-2413
Practice Address - Street 1:3251 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2305
Practice Address - Country:US
Practice Address - Phone:770-920-1884
Practice Address - Fax:770-920-2413
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0146381835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist