Individual
LOGAN BALKCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 382-7120
Mailing address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 382-7120
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
10709
GA
Other
Enumeration date
10/08/2021
Last updated
10/08/2021
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