Provider Demographics
NPI:1548208390
Name:BALCH, THOMAS STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:STEPHEN
Last Name:BALCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 MOUNTAIN CREEK TRL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3536
Mailing Address - Country:US
Mailing Address - Phone:404-255-6552
Mailing Address - Fax:
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 281
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1703
Practice Address - Country:US
Practice Address - Phone:404-252-3771
Practice Address - Fax:404-252-8011
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016015174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA016015OtherGEORGIA STATE LICENSE
GA016015OtherGEORGIA STATE LICENSE
GAAB6119134OtherDEA