MEDICARE: DR. KOMAL D BALANEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME95582	FL
2	207Q00000X	Family Medicine Physician	060435	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871506063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KOMAL D BALANEY MD

Provider Business Mailing Address
First Line	:	4375 JOHNS CREEK PKWY
Second Line	:	SUITE 320
City	:	SUWANEE
State	:	GA
Zip	:	30024-6085
Country	:	US
Telephone Number	:	770-623-1331
Fax Number	:	770-623-5674

Provider Business Practice Location Address
First Line	:	3890 JOHNS CREEK PKWY STE 230
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-1286
Country	:	US
Telephone Number	:	770-623-1331
Fax Number	:	770-623-5674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/12/2020

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Directions to “ DR. KOMAL D BALANEY MD” Practice Location

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