Individual
TALLIS LEAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD,DO
Contact information
Practice address
2940 TRAWICK RD STE 4, RALEIGH, NC 27604-3770
(919) 332-9235
Mailing address
2940 TRAWICK RD STE 4, RALEIGH, NC 27604-3770
(919) 332-9235
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
09/04/2021
Last updated
09/04/2021
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