Individual
DR. PHILIP K. TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2055 BEAVER RUIN RD, SUITE E, NORCROSS, GA 30071-3607
(770) 242-0021
(770) 242-6016
Mailing address
2055 BEAVER RUIN RD, SUITE E, NORCROSS, GA 30071-3607
(770) 242-0021
(770) 242-6016
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11970
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00934601A
—
GA
Enumeration date
03/27/2006
Last updated
07/09/2007
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