Healthcare Provider Details

I. General information

NPI: 1912357096
Provider Name (Legal Business Name): DARLA BALAS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7813 SPIVEY STATION BLVD SUITE 210
LAKE SPIVEY GA
30236-2900
US

IV. Provider business mailing address

1100 JOHNSON FERRY RD SUITE 510
SANDY SPRINGS GA
30342-1709
US

V. Phone/Fax

Practice location:
  • Phone: 770-507-0070
  • Fax: 770-507-7463
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN228938
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704374874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: