Organization
CHANCE TALLEY ENTERPRISES LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD B TALLEY MD (CO-OWNER)
(706) 829-8417
Entity
Organization
Contact information
Practice address
1850 N COLUMBIA ST STE 5, MILLEDGEVILLE, GA 31061-7115
(706) 829-8417
Mailing address
631 GARY ST, AUGUSTA, GA 30904-3509
(706) 829-8417
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700965100
—
GA
Enumeration date
05/06/2019
Last updated
05/06/2019
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