Baliga Family Practice Pc | |
1400 Bradley Lake Blvd Columbus GA 31904-3688 | |
(706) 593-7417 | |
(706) 507-2059 |
Full Name | Baliga Family Practice Pc |
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Speciality | Clinic/Center |
Location | 1400 Bradley Lake Blvd, Columbus, Georgia |
Authorized Official Name and Position | Bantwal P Baliga (PHYSICIAN) |
Authorized Official Contact | 7065072050 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Baliga Family Practice Pc 1400 Bradley Lake Blvd Columbus GA 31904-3688 Ph: (706) 507-2050 | Baliga Family Practice Pc 1400 Bradley Lake Blvd Columbus GA 31904-3688 Ph: (706) 593-7417 |
NPI Number | 1700094562 |
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Provider Enumeration Date | 05/17/2007 |
Last Update Date | 09/13/2022 |
Medicare PECOS PAC ID | 1153407721 |
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Medicare Enrollment ID | O20080324000066 |
Identifier | Type | State | Issuer |
---|---|---|---|
1700094562 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 056683 (Georgia) | Primary |
Provider Name | Bantwal Prathibha Baliga |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1730272584 PECOS PAC ID: 2466355276 Enrollment ID: I20060221000232 |
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