Provider Demographics
NPI:1184608838
Name:BALFOUR, TOSHA BEATRICE (MD)
Entity type:Individual
Prefix:MRS
First Name:TOSHA
Middle Name:BEATRICE
Last Name:BALFOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TOSHA
Other - Middle Name:
Other - Last Name:BALFOUR - WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 98446
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30359
Mailing Address - Country:US
Mailing Address - Phone:404-423-8881
Mailing Address - Fax:404-321-0223
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:SUITE G 03
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-501-6925
Practice Address - Fax:404-501-6930
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA92BBGDMMedicare PIN