=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154364123
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BALWINDER KAUR NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5985 PEACHTREE PKWY
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30092-2818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-449-0990
-----------------------------------------------------
Fax | 770-448-8818
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2905 PINEHIGH CT
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30096-7060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-449-3251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN141621
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------