Provider Demographics
NPI:1225024409
Name:BALAOING, WILMER M (MD)
Entity Type:Individual
Prefix:
First Name:WILMER
Middle Name:M
Last Name:BALAOING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:150 LULLWATER CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6756
Mailing Address - Country:US
Mailing Address - Phone:770-650-8272
Mailing Address - Fax:
Practice Address - Street 1:4441 ATLANTA RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6406
Practice Address - Country:US
Practice Address - Phone:770-702-1806
Practice Address - Fax:770-693-0810
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2018-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA56517207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI39213Medicare UPIN