Healthcare Provider Details

I. General information

NPI: 1538275912
Provider Name (Legal Business Name): EVAN A BALLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 S SWAIM STREET EXT
JONESVILLE NC
28642-9418
US

IV. Provider business mailing address

4000 S SWAIM STREET EXT
JONESVILLE NC
28642-9418
US

V. Phone/Fax

Practice location:
  • Phone: 336-835-6300
  • Fax: 336-835-4761
Mailing address:
  • Phone: 336-835-6300
  • Fax: 336-835-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22085
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: