Provider Demographics
NPI:1558834747
Name:BALKCUM, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BALKCUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RUSTIC OAKS CT
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-1516
Mailing Address - Country:US
Mailing Address - Phone:478-442-8587
Mailing Address - Fax:
Practice Address - Street 1:103 RUSTIC OAKS CT
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-1516
Practice Address - Country:US
Practice Address - Phone:478-442-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program