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General NPI Number Information
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NPI Number | 1972599363
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Entity Type | Individual
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Provider Name | NITI BHALLA CARLSON MD
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Gender | Female
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 465 N BELAIR RD STE 2E
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City | EVANS
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State | GA
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Zip | 30809-3190
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Country | US
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Telephone | 706-855-5510
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Fax | 706-855-7254
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Provider Business Mailing Address
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Address Line | 3829 HONORS WAY
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City | MARTINEZ
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State | GA
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Zip | 30907-9147
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Country | US
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Telephone | 706-855-5929
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 045052
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License Number State | GA
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