Basic Information
| Provider Information | |||||||||
| NPI: | 1053523456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALLEY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 801 OAK ST | ||||||||
| Address2: | |||||||||
| City: | ONEONTA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351211929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504612614 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | WETUMPKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 360921625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345674311 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2007 | ||||||||
| LastUpdateDate: | 04/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD 28606 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 28606 | AL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | FT2301125 | 01 | AL | DEA | OTHER | MD 28606 | 01 | AL | MEDICAL LICENSE | OTHER |