Healthcare Provider Details

I. General information

NPI: 1881677847
Provider Name (Legal Business Name): PAUL E BALLINGER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KINGTON LANE
CHICKAMAUGA GA
30707
US

IV. Provider business mailing address

7305 JARNIGAN ROAD SUITE 230
CHATTANOOGA TN
37421-4874
US

V. Phone/Fax

Practice location:
  • Phone: 706-375-9400
  • Fax: 706-375-9491
Mailing address:
  • Phone: 423-495-4345
  • Fax: 423-495-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001418
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: