Healthcare Provider Details

I. General information

NPI: 1497906234
Provider Name (Legal Business Name): SARAH A BALLARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 01/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E ALEX BELL RD
CENTERVILLE OH
45459-2658
US

IV. Provider business mailing address

1235 E ALEX BELL RD
CENTERVILLE OH
45459-2658
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-6400
  • Fax: 937-435-4793
Mailing address:
  • Phone: 937-435-6400
  • Fax: 937-435-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-002821
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: