Individual
DR. JACK L. TALLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
140 E MARIETTA ST, CANTON, GA 30114-3013
(770) 213-3594
(770) 315-3595
Mailing address
140 E MARIETTA ST, CANTON, GA 30114-3013
(770) 213-3594
(770) 315-3595
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1489
GA
Other
Enumeration date
05/19/2014
Last updated
05/19/2014
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