Provider Demographics
NPI:1659321107
Name:SOUTHERLAND, JOE TALTSON (DPM)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:TALTSON
Last Name:SOUTHERLAND
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:400 W ARBROOK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3174
Mailing Address - Country:US
Mailing Address - Phone:817-467-1990
Mailing Address - Fax:817-466-8737
Practice Address - Street 1:49 GORDON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:770-999-0804
Practice Address - Fax:770-999-0814
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2025-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1473213E00000X
GAPOD000709213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F8971OtherBCBS
TX8770B6Medicare PIN
TX8F21964Medicare PIN
TX8F8971Medicare ID - Type Unspecified
TX8F8971OtherBCBS
TX0889900002Medicare NSC