Provider Demographics
NPI:1700094562
Name:BALIGA FAMILY PRACTICE PC
Entity type:Organization
Organization Name:BALIGA FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BANTWAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BALIGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-507-2050
Mailing Address - Street 1:1400 BRADLEY LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3688
Mailing Address - Country:US
Mailing Address - Phone:706-507-2050
Mailing Address - Fax:706-507-2059
Practice Address - Street 1:1400 BRADLEY LAKE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3688
Practice Address - Country:US
Practice Address - Phone:706-593-7417
Practice Address - Fax:706-507-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056683261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH76948Medicare UPIN