Provider Demographics
NPI:1508606963
Name:INNER BALANCE LLC
Entity type:Organization
Organization Name:INNER BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:229-350-6455
Mailing Address - Street 1:281 PIERCE CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-6766
Mailing Address - Country:US
Mailing Address - Phone:229-350-6455
Mailing Address - Fax:
Practice Address - Street 1:281 PIERCE CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-6766
Practice Address - Country:US
Practice Address - Phone:229-350-6455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty