Healthcare Provider Details

I. General information

NPI: 1518897362
Provider Name (Legal Business Name): CHIQUITA GUEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHIQUITA GUEST STANLEY

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 BELLEMEADE DR
AUGUSTA GA
30906-3102
US

IV. Provider business mailing address

3116 BELLEMEADE DR
AUGUSTA GA
30906-3102
US

V. Phone/Fax

Practice location:
  • Phone: 803-782-4761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOPI.1252
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: