Basic Information
| Provider Information | |||||||||
| NPI: | 1023572849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALKCOM | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4170 HWY 197 NORTH | ||||||||
| Address2: | LAKE BURTON | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789202686 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 NORTHSIDE FORSYTH DR STE 450 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300418483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704421911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2019 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 9122 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.