Individual
KELLY QUIANA TALBERT THAGGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3872 HIGHWAY 5, DOUGLASVILLE, GA 30135-3366
(770) 949-5535
(770) 949-9022
Mailing address
3872 HIGHWAY 5, DOUGLASVILLE, GA 30135-3366
(770) 949-5535
(770) 949-9022
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN256952
GA
Other
Enumeration date
12/15/2022
Last updated
01/31/2023
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