| Chance Talley Enterprises Llc. | |
|
1850 N Columbia St Ste 5 Milledgeville GA 31061-7115 | |
| (706) 829-8417 | |
| Not Available |
| Full Name | Chance Talley Enterprises Llc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1850 N Columbia St Ste 5, Milledgeville, Georgia |
| Authorized Official Name and Position | Donald B Talley (CO-OWNER) |
| Authorized Official Contact | 7068298417 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chance Talley Enterprises Llc. 631 Gary St Augusta GA 30904-3509 Ph: (706) 829-8417 | Chance Talley Enterprises Llc. 1850 N Columbia St Ste 5 Milledgeville GA 31061-7115 Ph: (706) 829-8417 |
| NPI Number | 1265097240 |
|---|---|
| Provider Enumeration Date | 05/06/2019 |
| Last Update Date | 05/06/2019 |
| Medicare PECOS PAC ID | 6002233905 |
|---|---|
| Medicare Enrollment ID | O20200824001716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265097240 | NPI | - | NPPES |
| 1700965100 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | William Perry Giles |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1912018946 PECOS PAC ID: 0941286108 Enrollment ID: I20040628001007 |
| Provider Name | James B Craig |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1114967742 PECOS PAC ID: 2062551294 Enrollment ID: I20091202000019 |
| Provider Name | Libertad Melendez |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1124083886 PECOS PAC ID: 9335276393 Enrollment ID: I20100422000635 |
| Provider Name | Sima Dori |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1952617300 PECOS PAC ID: 4880882000 Enrollment ID: I20110103000443 |
| Provider Name | Rickey Harton |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1609861129 PECOS PAC ID: 6507881117 Enrollment ID: I20111101000443 |
| Provider Name | Puja Patel |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1174936876 PECOS PAC ID: 8921225640 Enrollment ID: I20150821014737 |
| Provider Name | Michael Wesson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1285695916 PECOS PAC ID: 5991873887 Enrollment ID: I20200825000548 |
| Provider Name | Antonio Campbell |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1912107905 PECOS PAC ID: 5698926012 Enrollment ID: I20230130002395 |
| Provider Name | Joseph Pruitt |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1477752913 PECOS PAC ID: 8921187477 Enrollment ID: I20230320002083 |
| Provider Name | Arpit Patel |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1710595368 PECOS PAC ID: 1254729684 Enrollment ID: I20230502001113 |
| Provider Name | Amy Ruzicka |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1508368556 PECOS PAC ID: 8022372887 Enrollment ID: I20240125001010 |
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