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Individual

DR. NITI BHALLA CARLSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
465 N BELAIR RD STE 2E, EVANS, GA 30809-3190
(706) 855-5510
(706) 855-7254
Mailing address
3829 HONORS WAY, MARTINEZ, GA 30907-9147
(706) 855-5929

Taxonomy

Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
045052
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00914955B
GA
01
G45052
MEDICAID
SC
Enumeration date
09/21/2005
Last updated
05/21/2020
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