Provider Demographics
NPI:1194720896
Name:TALLON, DONNA K (DPM)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:K
Last Name:TALLON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 W DYKES ST
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-6844
Mailing Address - Country:US
Mailing Address - Phone:478-934-0776
Mailing Address - Fax:478-934-0779
Practice Address - Street 1:222 PERRY HWY
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-783-0299
Practice Address - Fax:478-783-3730
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000873213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA083092277JMedicaid
GA083092277BMedicaid
GA083092277CMedicaid
GA083092277EMedicaid
GA083092277MMedicaid
GA083092277DMedicaid
GA083092277AMedicaid
GA083092277CMedicaid
GA083092277DMedicaid