Individual
MARK A TALLEY
Active
Individual
MARK A TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
17819
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000674561
—
GA
05
—
009932806
—
AL
01
—
300050345
RR MCARE-ADR
TN
01
—
300063281
RR MCARE-CI
TN
01
—
3029755
ADR BC/BS OF TN
TN
05
—
3036089
—
TN
01
—
3049719
PLAZA BC/BS OF TN
TN
Enumeration date
07/12/2006
Last updated
11/12/2018
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