Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR008063 | GA |
NPI | 1265757215 |
---|---|
Provider Name | Louise Watkins Tallman |
First Address | Alpharetta, GA 30022-5146 |
Second Address | Alpharetta, GA 30022-5146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2010 |
Last Update Date | 01/04/2010 |