Healthcare Provider Details

I. General information

NPI: 1235789066
Provider Name (Legal Business Name): SARAH E BALK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH VIRGINIA ELLISON PA

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COLLIER RD NW STE 500
ATLANTA GA
30309-1711
US

IV. Provider business mailing address

790 HUFF RD NW APT 6030
ATLANTA GA
30318-4387
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2800
  • Fax:
Mailing address:
  • Phone: 706-831-2748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9467
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: