Healthcare Provider Details

I. General information

NPI: 1154344836
Provider Name (Legal Business Name): CHARLES A BALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 W JAMES CAMPBELL BLVD SUITE 403
COLUMBIA TN
38401-4659
US

IV. Provider business mailing address

854 W JAMES CAMPBELL BLVD SUITE 303
COLUMBIA TN
38401-4659
US

V. Phone/Fax

Practice location:
  • Phone: 931-380-0075
  • Fax: 931-388-7502
Mailing address:
  • Phone: 931-540-4255
  • Fax: 931-388-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10356
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: