Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 30737 | TN |
NPI | 1093730343 |
---|---|
Provider Name | Gregory A. Talbott |
First Address | Chattanooga, TN 37401-2503 |
Second Address | Chattanooga, TN 37403-1405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 23/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G20286 | (02) | TN |