Healthcare Provider Details

I. General information

NPI: 1699869321
Provider Name (Legal Business Name): KAREN E. BALLARD-MONTGOMERY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28921 HIGHWAY 5
WOODSTOCK AL
35188
US

IV. Provider business mailing address

405 BELCHER STREET
CENTREVILLE AL
35042
US

V. Phone/Fax

Practice location:
  • Phone: 205-938-9348
  • Fax: 205-938-9020
Mailing address:
  • Phone: 205-926-2992
  • Fax: 205-316-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00020185
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.20185
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: