Healthcare Provider Details

I. General information

NPI: 1639253677
Provider Name (Legal Business Name): SANDRA LEE BALLARD RN CRNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 OLD JOHNSON RD
MURPHY NC
28906-7775
US

IV. Provider business mailing address

1000 JOHNSON FERRY RD NE NORTHSIDE HOSPITAL
ATLANTA GA
30342-1606
US

V. Phone/Fax

Practice location:
  • Phone: 828-644-4591
  • Fax:
Mailing address:
  • Phone: 404-851-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN138282
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: