Kelly Tally, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

POD001396 Issued in GA

Practice address

1300 Peachtree Industrial Blvd Ste 4105
Suwanee, GA 30024-4541

Phone

(470) 589-1204

Fax

(470) 589-1465

NPI assigned

Jan 14, 2019

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

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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

• Suwanee Foot and Ankle Specialists LLC

  • Foot & Ankle Surgery Podiatrist
  • Suwanee, GA
  • NPI 1184292138
  Medicare reassignment NPD

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

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677974400000",
    "number": "1932673902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD STE 4105",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244541",
            "telephone_number": "470-589-1204",
            "fax_number": "470-589-1465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 PEACHTREE INDUSTRIAL BLVD STE 4105",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300244541",
            "telephone_number": "470-589-1204",
            "fax_number": "470-589-1465"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "590 S Enota Dr NE Ste 1",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "GA",
            "postal_code": "305012433",
            "country_code": "US",
            "telephone_number": "470-252-5756",
            "fax_number": "470-252-5829",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2701 N Decatur Rd",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "GA",
            "postal_code": "300335918",
            "country_code": "US",
            "telephone_number": "404-501-7188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TALLY",
        "first_name": "KELLY",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-14",
        "last_updated": "2023-03-05",
        "certification_date": "2023-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "GA",
            "license": "POD001396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sys6650
• Michael Sytsma
• Khanh Ta
• Nedim Tabakovic, RBT
• Ngano Tongesai Frank Takawira, MD
• Tommy Lee Tally, D.P.M.
• Lee R Tanenbaum, M.A., CCC
• Linda Tang, FNP-C
• Qiansha Tang, PHARM.D
• Thanh Tang, DMD

• Foot & Ankle Surgery Podiatrist in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Foot & Ankle Surgery Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.