Healthcare Provider Details

I. General information

NPI: 1629023825
Provider Name (Legal Business Name): TAMARA BALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAPLES ROAD
FLETCHER NC
28732
US

IV. Provider business mailing address

PO BOX 532666
ATLANTA GA
30353-2666
US

V. Phone/Fax

Practice location:
  • Phone: 904-805-1300
  • Fax: 904-805-1302
Mailing address:
  • Phone: 904-805-1300
  • Fax: 904-805-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9400409
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: