MEDICARE: DR. LAURENCE BRUCE BALTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	MD034197	DC
2	207RI0200X	Infectious Disease Physician	D0060299	MD
3	207RI0200X	Infectious Disease Physician	079046	GA

General Provider Information

NPI Number	:	1326037201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURENCE BRUCE BALTER MD

Provider Business Mailing Address
First Line	:	550 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2247
Country	:	US
Telephone Number	:	404-686-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2247
Country	:	US
Telephone Number	:	404-686-4411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	03/17/2018

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