REAGAN AMBER BALOG (NPI# 1124501077) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124501077 |
| Entity Type | Individual |
| Full Name | REAGAN AMBER BALOG |
| Practice Address |
2330 S Milledge Ave Athens GA 30605-1622 |
| Mailing Address |
330 River Rd Athens GA 30602-6114 |
| Practice Telephone | 7703293353 |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2018-09-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
2330 S MILLEDGE AVE |
| City | ATHENS |
| State | GA |
| Zip Code | 30605-1622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811413701 | Lifecare Pharmacy Ga Corp | Pharmacy | 130 Gains School Rd, Athens, GA 30605 | 2017-08-22 |
| 1194245423 | Melissa Brooke Wilson | Speech-Language Pathologist | 345 Research Drive Apartment 76, Athens, GA 30605 | 2017-06-27 |
| 1467982512 | Beth Kay Mcdonald | Counselor | 455 S Lumpkin St, Athens, GA 30605 | 2017-06-12 |
| 1841741063 | Jessica Parker | Specialist | 1060 Gaines School Rd, Suite A4c, Athens, GA 30605 | 2016-10-24 |
| 1417374869 | Northeast Georgia Wellness Associates, LLC | Dietitian, Registered | 1197 Cedar Shoals Drive #103, Athens, GA 30605 | 2014-03-24 |
| 1245571272 | Optimum Medical Healthcare | Durable Medical Equipment & Medical Supplies | 1715 Cedar Shoals Drive, Athens, GA 30605 | 2013-03-15 |
| 1972850709 | Sandra Joy Motte | Occupational Therapy Assistant | 275 Woodgrove Dr, Athens, GA 30605 | 2012-08-10 |
| 1124309851 | Kasey Brown | Social Worker | 188 S. Milledge Ave., Suite 2, Athens, GA 30605 | 2011-09-08 |
| 1154652071 | Chris Mayo Counseling and Psychotherapy, Lcsw, LLC | Social Worker | 135 Milford Dr, Athens, GA 30605 | 2010-01-15 |
| 1700039732 | Andrew Case | Psychologist | 105a Cedar Rock Trace, Suite 5, Athens, GA 30605 | 2008-11-04 |
| Find all providers in zip 30605 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942816962 | Kofi Darkwa Seffah | Student in an Organized Health Care Education/Training Program | 1199 Prince Ave #70, 1270 Prince Ave Suite 201, Athens, GA 30606 | 2020-09-16 |
| 1912522996 | Robert Michael Hewgley | Student in an Organized Health Care Education/Training Program | 460 County Road 603, Athens, TN 37303-6266 | 2020-06-15 |
| 1497375612 | Alfred Ka-shing Wong | Student in an Organized Health Care Education/Training Program | 1270 Prince Ave Suite 201, Athens, GA 30606 | 2020-04-17 |
| 1063031342 | Francisca Gonzalez | Student in an Organized Health Care Education/Training Program | 25203 Airport Rd, Athens, AL 35614-6006 | 2020-04-15 |
| 1164051926 | Rachel Staker | Student in an Organized Health Care Education/Training Program | 86 Circle Drive, Suite 203, Athens, OH 45701 | 2020-04-03 |
| 1164059317 | Ling Fang Guo | Student in an Organized Health Care Education/Training Program | 204 Grosvenor Hl, Athens, OH 45701-1775 | 2020-03-26 |
| 1932736709 | Maria Augusta Suarez-hamman | Student in an Organized Health Care Education/Training Program | 86 Columbus Circle, Suite 203, Athens, OH 45701 | 2020-03-23 |
| 1861045809 | Taylor Kathryn Hallenbeck | Student in an Organized Health Care Education/Training Program | 198 Bonita Hills Rd, Athens, GA 30605-4629 | 2019-07-18 |
| 1811559750 | Prakash Adhikari | Student in an Organized Health Care Education/Training Program | 1199 Prince Ave Ste 70, Athens, GA 30606-2797 | 2019-07-01 |
| 1760045223 | Dominic Ofosu Amakye | Student in an Organized Health Care Education/Training Program | 1270 Prince Avenue Suite 201, Athens, GA 30606 | 2019-04-19 |
| Find all providers in ATHENS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.