Provider Demographics
NPI:1184452559
Name:TALLEY, CHISA (DHA, LNHA)
Entity type:Individual
Prefix:DR
First Name:CHISA
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:DHA, LNHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 FORREST BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5347
Mailing Address - Country:US
Mailing Address - Phone:662-889-6120
Mailing Address - Fax:
Practice Address - Street 1:610 FORREST BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5347
Practice Address - Country:US
Practice Address - Phone:662-889-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health