1275573776 NPI number — DR. REBECCA ANNE TALLEY MD

Table of content: JAMIE E JACKSON DC (NPI 1194830240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275573776 NPI number — DR. REBECCA ANNE TALLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALLEY
Provider First Name:
REBECCA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275573776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30809-2510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-922-8251
Provider Business Mailing Address Fax Number:
706-922-6695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 MAGNOLIA WAY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30909-9483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-922-6600
Provider Business Practice Location Address Fax Number:
706-650-0239
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  47268 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10056668 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: G47268 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 338184 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 047268 . This is a "LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00825272A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH0654 . This is a "RR MEDICARE GROUP PIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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