Provider Demographics
NPI:1245543123
Name:CHANCE
Entity type:Organization
Organization Name:CHANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:G
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-227-1404
Mailing Address - Street 1:1645 N 2ND STREET EXT
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1638
Mailing Address - Country:US
Mailing Address - Phone:770-227-1404
Mailing Address - Fax:770-227-1404
Practice Address - Street 1:1645 N 2ND STREET EXT
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1638
Practice Address - Country:US
Practice Address - Phone:770-227-1404
Practice Address - Fax:770-227-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA302R00000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization