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General NPI Number Information
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NPI Number | 1982530705
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Entity Type | Individual
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Provider Name | JOLIE CLAIRE BALTZEGAR
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Gender | Female
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Dates
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Enumeration Date | 06/19/2026
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Last Update Date | 06/19/2026
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Provider Practice Location Address
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Address Line | 625 OLD PEACHTREE RD NW
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City | SUWANEE
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State | GA
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Zip | 30024-2937
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Country | US
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Telephone | 678-225-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 3151 STILLHOUSE CREEK DR SE UNIT 4319
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City | ATLANTA
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State | GA
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Zip | 30339-3545
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 390200000X
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License Number State | GA
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