Provider Demographics
NPI:1912001421
Name:TALLEY, THOMAS CARTER (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CARTER
Last Name:TALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1918
Mailing Address - Country:US
Mailing Address - Phone:229-883-4555
Mailing Address - Fax:229-888-0063
Practice Address - Street 1:414 5TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1918
Practice Address - Country:US
Practice Address - Phone:229-883-4555
Practice Address - Fax:229-888-0063
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033895207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000477474AMedicaid
GABT2632126OtherDEA
GA000477474AMedicaid
GA16BDTLMMedicare ID - Type Unspecified