Healthcare Provider Details

I. General information

NPI: 1902067424
Provider Name (Legal Business Name): PERCY RAY BALLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SOUTHERN AVE
DORCHESTER CENTER MA
02124-2012
US

IV. Provider business mailing address

829 WOODBURN DR
BRENTWOOD TN
37027-8728
US

V. Phone/Fax

Practice location:
  • Phone: 617-901-4569
  • Fax: 615-777-2154
Mailing address:
  • Phone: 617-901-4569
  • Fax: 615-777-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number249194
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number63652
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: