Healthcare Provider Details

I. General information

NPI: 1679790141
Provider Name (Legal Business Name): JABALEY VISION ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 DAMASCUS CIRCLE
BLUE RIDGE GA
30513
US

IV. Provider business mailing address

1333 DAMASCUS CIRCLE
BLUE RIDGE GA
30513
US

V. Phone/Fax

Practice location:
  • Phone: 706-946-2020
  • Fax: 706-946-2021
Mailing address:
  • Phone: 706-946-2020
  • Fax: 706-946-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1752
License Number StateGA

VIII. Authorized Official

Name: DR. SAMUEL CHRISTOPHER JABALEY
Title or Position: PRESIDENT
Credential: O.D.
Phone: 706-946-2020