Provider Demographics
NPI:1861483497
Name:TALLEY, JOSEPH L III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:TALLEY
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1008 KIOKEE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9378
Mailing Address - Country:US
Mailing Address - Phone:229-432-1908
Mailing Address - Fax:229-434-2502
Practice Address - Street 1:2000 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1528
Practice Address - Country:US
Practice Address - Phone:229-434-2111
Practice Address - Fax:229-434-2502
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085920367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA43ZCCCR01Medicare PIN
GAS62862Medicare UPIN