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General NPI Number Information
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NPI Number | 1104827252
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Entity Type | Individual
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Provider Name | JAMES C BALLENGER M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 192 E BAY ST STE 204
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City | CHARLESTON
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State | SC
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Zip | 29401-2171
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Country | US
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Telephone | 843-937-5950
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Fax | 843-937-5951
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Provider Business Mailing Address
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Address Line | 24 SEAGRASS LN
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City | ISLE OF PALMS
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State | SC
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Zip | 29451-3853
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Country | US
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Telephone | 843-886-0907
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Fax | 843-886-4093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 11650
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License Number State | SC
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