Provider Demographics
NPI:1538703038
Name:SCOTT ERIC BALOGH
Entity Type:Organization
Organization Name:SCOTT ERIC BALOGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BALOGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-305-6789
Mailing Address - Street 1:65 GERMANTOWN COURT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018
Mailing Address - Country:US
Mailing Address - Phone:901-305-6789
Mailing Address - Fax:901-305-6973
Practice Address - Street 1:65 GERMANTOWN COURT
Practice Address - Street 2:SUITE 203
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018
Practice Address - Country:US
Practice Address - Phone:901-305-6789
Practice Address - Fax:901-305-6973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty