NPIMap

Organization Active NPI

Chance Talley Enterprises LLC.

  • Clinic/Center
  • Milledgeville, GA
National Provider Identifier
1265097240
Registry record updated May 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
CHANCE TALLEY ENTERPRISES LLC.
Practice address
1850 N Columbia St Ste 5
Milledgeville, GA 31061-7115
Phone
(706) 829-8417
NPI assigned
May 6, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2019

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

Authorized official

Name
Dr. Donald B Talley, MDNPI 1700965100
Title
Co-Owner
Phone
(706) 829-8417

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1850 N Columbia St Ste 5
Milledgeville, GA 31061-7115

Mailing address

631 Gary St
Augusta, GA 30904-3509
Phone (706) 829-8417

Other identifiers 1

IdentifierTypeStateIssuer
1700965100MedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200824001716 GA Part B Supplier - Clinic/Group Practice 6002233905 Receives reassigned benefits from 23 practitioners
Practice locations: Milledgeville, GA

National Provider Directory

National Provider Directory

Locations

1850 N Columbia St
Ste 5
Milledgeville, GA 31061
Phone (478) 453-0011

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557100800000",
    "number": "1265097240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 GARY ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309043509",
            "telephone_number": "706-829-8417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 N COLUMBIA ST STE 5",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310617115",
            "telephone_number": "706-829-8417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANCE TALLEY ENTERPRISES LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-06",
        "last_updated": "2019-05-06",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "706-829-8417",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700965100",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milledgeville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.