Individual
STEVE BALLESTEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2206 CAMILLE DR, SUITE C, COLUMBUS, GA 31906-1002
(706) 442-2249
(762) 208-4985
Mailing address
2206 CAMILLE DR, SUITE C, COLUMBUS, GA 31906-1002
(706) 442-2249
(762) 208-4985
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
131812
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
474359436
TRICARE
GA
Enumeration date
07/07/2015
Last updated
07/07/2015
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