Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301114524 | MI |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 88995 | GA |
NPI | 1205255056 |
---|---|
Provider Name | Ciara Shanis Talbot |
First Address | Detroit, MI 48207-2980 |
Second Address | Atlanta, GA 30309-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 18/01/2022 |