Individual
MARK A TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 25TH AVE N STE 602, NASHVILLE, TN 37203
(615) 312-1479
(615) 320-3259
Mailing address
210 25TH AVE N STE 602, NASHVILLE, TN 37203-1631
(615) 312-1479
(615) 320-3259
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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