Individual
TALLEY S SOFIANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8832 US HIGHWAY 90, DAPHNE, AL 36526-8932
(251) 289-1786
Mailing address
14557 HIGHWAY 19 STE A, GRIFFIN, GA 30224-9582
(678) 688-1580
(678) 688-1594
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
006755
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
GA
Enumeration date
03/13/2013
Last updated
02/28/2024
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