Provider Demographics
NPI:1871506063
Name:BALANEY, KOMAL D (MD)
Entity type:Individual
Prefix:DR
First Name:KOMAL
Middle Name:D
Last Name:BALANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4375 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6085
Mailing Address - Country:US
Mailing Address - Phone:770-623-1331
Mailing Address - Fax:770-623-5674
Practice Address - Street 1:3890 JOHNS CREEK PKWY STE 230
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1286
Practice Address - Country:US
Practice Address - Phone:770-623-1331
Practice Address - Fax:770-623-5674
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95582207Q00000X
GA060435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
GAPENDINGMedicaid
GAPENDINGMedicare UPIN
FLPENDINGMedicaid
FLPENDINGMedicare ID - Type Unspecified