Provider Demographics
NPI:1346688058
Name:NITI BHALLA CARLSON MD PC
Entity Type:Organization
Organization Name:NITI BHALLA CARLSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NITI
Authorized Official - Middle Name:BHALLA
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-736-2273
Mailing Address - Street 1:2258 WRIGHTSBORO RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4887
Mailing Address - Country:US
Mailing Address - Phone:706-736-2273
Mailing Address - Fax:706-736-7171
Practice Address - Street 1:2258 WRIGHTSBORO RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4887
Practice Address - Country:US
Practice Address - Phone:706-736-2273
Practice Address - Fax:706-736-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045052207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty