Individual
FNU PRAVEEN BALASUBRAMANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201-2102
(478) 633-7550
Mailing address
777 HEMLOCK ST, MACON, GA 31201-2102
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27736
FL
Other
Enumeration date
07/16/2018
Last updated
06/26/2021
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