Provider Demographics
NPI:1285819615
Name:POLEY, PREETI R (MD)
Entity Type:Individual
Prefix:
First Name:PREETI
Middle Name:R
Last Name:POLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-5448
Mailing Address - Country:US
Mailing Address - Phone:706-535-7473
Mailing Address - Fax:706-740-7473
Practice Address - Street 1:115 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-5448
Practice Address - Country:US
Practice Address - Phone:706-535-7473
Practice Address - Fax:706-740-7473
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC81858207W00000X
GA082059207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036127346OtherILLINOIS LICENSE
IN01071747AOtherINDIANA LICENSE
IL036127346Medicaid
IL036127346OtherMEDICAL LICENSE
IN201147260Medicaid
IN496710OtherMEDICARE
IL790730006OtherMEDICARE PTAN