Healthcare Provider Details

I. General information

NPI: 1730147034
Provider Name (Legal Business Name): KYTIA S BALCAREK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 F JOHNSON FERRY RD STE 370
ATLANTA GA
30342
US

IV. Provider business mailing address

993 F JOHNSON FERRY RD STE 370
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-4611
  • Fax: 404-256-1759
Mailing address:
  • Phone: 404-252-4611
  • Fax: 404-256-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number045713
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number045713
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: