Provider Demographics
NPI:1083769632
Name:BALUN, BROOKE POINDEXTER (CNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:POINDEXTER
Last Name:BALUN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1606
Mailing Address - Country:US
Mailing Address - Phone:404-851-8000
Mailing Address - Fax:404-851-6325
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-851-8000
Practice Address - Fax:404-851-6325
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000784715IMedicaid
GA000784715EMedicaid
GA202I509114Medicare PIN
GA000784715EMedicaid
GAS50203Medicare UPIN