Individual
BALU S MANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
119 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2540
(770) 991-1010
Mailing address
PO BOX 100032, KENNESAW, GA 30156-9232
(770) 312-5536
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036920
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000544893
—
GA
Enumeration date
12/29/2005
Last updated
07/30/2025
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