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General NPI Number Information
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NPI Number | 1629201280
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Entity Type | Individual
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Provider Name | JOSH A. BALSLY PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 1 MEDICAL DR
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City | BENSON
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State | NC
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Zip | 27504-1177
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Country | US
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Telephone | 919-894-1740
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Fax | 919-894-2701
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Provider Business Mailing Address
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Address Line | 1513 ESSEXWOOD DR
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-5374
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Country | US
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Telephone | 919-285-4936
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-01877
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0010-01877
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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