Provider Demographics
NPI:1851087258
Name:ZELLNER, TALIA BETHANY (A-GPCNP)
Entity Type:Individual
Prefix:MRS
First Name:TALIA
Middle Name:BETHANY
Last Name:ZELLNER
Suffix:
Gender:F
Credentials:A-GPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 FENHURST PL
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5308
Mailing Address - Country:US
Mailing Address - Phone:773-900-1123
Mailing Address - Fax:
Practice Address - Street 1:101 QUARTZ DR STE 203
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3256
Practice Address - Country:US
Practice Address - Phone:770-812-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN303592363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care