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General NPI Number Information
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NPI Number | 1720116452
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Entity Type | Individual
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Provider Name | SHANGEETHA BALAKUMAR MD
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 280 COBB PKWY S STE 60
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City | MARIETTA
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State | GA
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Zip | 30060-6531
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Country | US
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Telephone | 678-820-7373
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 1 EMBARCADERO CTR STE 1900
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-3723
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Country | US
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Telephone |
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Fax | 415-252-7176
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61603067
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 83851
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0073998
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LL28993
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME105139
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License Number State | FL
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