Provider Demographics
NPI:1447833280
Name:TALLEY, VICTORIA D (MD)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:D
Last Name:TALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:D
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:114B HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3226
Mailing Address - Country:US
Mailing Address - Phone:864-535-6855
Mailing Address - Fax:
Practice Address - Street 1:114B HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3226
Practice Address - Country:US
Practice Address - Phone:864-535-6855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine