Individual
TIMOTHY R THALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1497 FAIR RD STE 102, STATESBORO, GA 30458-0823
(912) 764-9001
(912) 764-3166
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
046818
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000829507B
—
GA
01
—
340016471
RR MEDICARE
GA
01
—
782637
BCBS
GA
Enumeration date
08/23/2005
Last updated
02/09/2026
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