Individual
MR. NESTOR ANTONIO BALDIZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
148 CLINIC AVE, CARROLLTON, GA 30117-4414
(770) 838-8640
(770) 838-8650
Mailing address
119 AMBULANCE DR, SUITE 202, CARROLLTON, GA 30117-3857
(770) 838-8640
(770) 838-8650
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004239
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253274100B
—
GA
Enumeration date
11/04/2005
Last updated
06/30/2014
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