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General NPI Number Information
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NPI Number | 1538703038
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Entity Type | Organization
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Legal Business Name | SCOTT ERIC BALOGH
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 65 GERMANTOWN COURT SUITE 203
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City | CORDOVA
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State | TN
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Zip | 38018
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Country | US
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Telephone | 901-305-6789
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Fax | 901-305-6973
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Provider Business Mailing Address
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Address Line | 65 GERMANTOWN COURT SUITE 203
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City | CORDOVA
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State | TN
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Zip | 38018
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Country | US
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Telephone | 901-305-6789
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Fax | 901-305-6973
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT ERIC BALOGH
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Credential | M.D.
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Telephone | 901-305-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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