Provider Demographics
NPI:1801558291
Name:TALLEY, RENARD LABRACHE
Entity type:Individual
Prefix:MR
First Name:RENARD
Middle Name:LABRACHE
Last Name:TALLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 THE EXCHANGE SE STE 330-L
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7400
Mailing Address - Country:US
Mailing Address - Phone:470-552-4073
Mailing Address - Fax:
Practice Address - Street 1:1755 THE EXCHANGE SE STE 330-L
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7400
Practice Address - Country:US
Practice Address - Phone:470-552-4073
Practice Address - Fax:470-235-4748
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care