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General NPI Number Information
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NPI Number | 1255778817
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Entity Type | Individual
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Provider Name | SRI RAHUL BALUSU M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 531 ASBURY CIR SUITE N340
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City | ATLANTA
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State | GA
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Zip | 30322-1006
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Country | US
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Telephone | 404-778-5975
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Fax | 404-778-2630
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Provider Business Mailing Address
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Address Line | 1009 CALIBRE WOODS DR NE NONE
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City | ATLANTA
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State | GA
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Zip | 30329-3948
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Country | US
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Telephone | 770-335-3321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 73111
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License Number State | GA
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