Individual
NICHOLAS MARK BALOGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1932 ALCOA HWY, STE 360, KNOXVILLE, TN 37920-1509
(865) 524-1869
(865) 544-6533
Mailing address
1932 ALCOA HWY, STE 360, KNOXVILLE, TN 37920-1509
(865) 524-1869
(865) 544-6533
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1801
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518131
—
TN
Enumeration date
02/18/2010
Last updated
11/20/2019
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