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Individual

TALLEY COLLINS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
218 STONEWALL ST, CARTERSVILLE, GA 30120-3628
(678) 719-0177
Mailing address
275 NORTH AVE, FAIRMOUNT, GA 30139-2937

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN099777
GA

Other

Enumeration date
11/01/2021
Last updated
11/01/2021
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