Provider Demographics
NPI:1023572849
Name:BALKCOM, SARAH ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:BALKCOM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 HWY 197 NORTH
Mailing Address - Street 2:LAKE BURTON
Mailing Address - City:CLARKSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523
Mailing Address - Country:US
Mailing Address - Phone:678-920-2686
Mailing Address - Fax:
Practice Address - Street 1:1800 NORTHSIDE FORSYTH DR STE 450
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8483
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9122363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical