Individual
ANTHONY M BALISTRERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2675 N DECATUR RD, SUITE 506, DECATUR, GA 30033-6131
(404) 299-1679
(404) 508-7694
Mailing address
2675 N DECATUR RD, SUITE 506, DECATUR, GA 30033-6131
(404) 299-1679
(404) 508-7694
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
52424
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52424
STATE LICENSE
GA
Enumeration date
06/13/2006
Last updated
07/05/2012
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