Individual
LEE BALOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3950 AUSTELL RD, AUSTELL, GA 30106
(770) 732-3649
(770) 732-3648
Mailing address
PO BOX 155, AUSTELL, GA 30168-1002
(770) 732-3649
(770) 732-3648
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN108726
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000888324B
—
GA
Enumeration date
04/06/2006
Last updated
12/15/2009
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