Healthcare Provider Details

I. General information

NPI: 1649245218
Provider Name (Legal Business Name): JAMES W BALLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 WINTON M BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

IV. Provider business mailing address

249 WINTON M BLOUNT LOOP
MONTGOMERY AL
36117-3507
US

V. Phone/Fax

Practice location:
  • Phone: 334-213-0036
  • Fax: 334-213-0166
Mailing address:
  • Phone: 334-213-0036
  • Fax: 334-213-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00003463
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME72144
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38202
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number00003463
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberME72144
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number38202
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: