Healthcare Provider Details

I. General information

NPI: 1689510950
Provider Name (Legal Business Name): LEAH BALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 NEWNAN RD
GRIFFIN GA
30223-7114
US

IV. Provider business mailing address

1270 KENDRICK RD
MILNER GA
30257-4028
US

V. Phone/Fax

Practice location:
  • Phone: 770-467-9930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP310344
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: