Talley S Sofianos, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

006755 Issued in GA

Practice address

8832 US Highway 90
Daphne, AL 36526-8932

Phone

(251) 289-1786

NPI assigned

Mar 13, 2013

Last updated

Feb 28, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aqua Dermatology of Alabama PCGroup PAC ID 9436211463, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HFBDAA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Aqua Dermatology of Alabama PC

  dba Sunrise Dermatology

  • MOHS-Micrographic Surgery Physician
  • Vestavia HLS, AL
  • NPI 1477708642
  Medicare reassignment Care Compare group
• Summit Dermatology and Spa LLC

  • Medical Specialty Clinic/Center
  • Pensacola, FL
  • NPI 1578206785
  Medicare reassignment NPD
• Cutaneous Oncology & Surgery Center, LLC

  dba SmoothRock Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Vestavia HLS, AL
  • NPI 1699139915
  NPD (past)
• Coker Pediatrics LLC

  • Pediatrics Physician
  • Griffin, GA
  • NPI 1871707489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1053652271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14557 HIGHWAY 19 STE A",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302249582",
            "telephone_number": "678-688-1580",
            "fax_number": "678-688-1594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8832 US HIGHWAY 90",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365268932",
            "telephone_number": "251-289-1786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14557 Highway 19 Ste A",
            "address_purpose": "LOCATION",
            "city": "Griffin",
            "state": "GA",
            "postal_code": "302249582",
            "country_code": "US",
            "telephone_number": "678-688-1580 x107",
            "fax_number": "678-688-1594",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOFIANOS",
        "first_name": "TALLEY",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-13",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "006755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Smith, CRNP
• Tara Smith, PHARMD
• Taylor Smith
• Wesley R Smith, PHARMD
• Whitney Smith, SLP
• Simara Sokom, PHARM.D.
• Solid Rock Counseling, LLC
• Kay Bush Sorrells, LPC
• South Alabama Dermatology and Surgery Center LLC (South Alabama Dermatology)
• Southeast Functional Chiropractic

• Medical Physician Assistant in Daphne, AL
• Providers in Daphne, AL by specialty
• Medical Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.