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General NPI Number Information
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NPI Number | 1154437598
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Entity Type | Organization
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Legal Business Name | JONESVILLE FAMILY MEDICAL CENTER, P.A.
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 4000 S SWAIM STREET EXT
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City | JONESVILLE
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State | NC
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Zip | 28642-9418
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Country | US
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Telephone | 336-835-6300
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Fax | 336-835-4761
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Provider Business Mailing Address
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Address Line | 4000 S SWAIM STREET EXT
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City | JONESVILLE
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State | NC
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Zip | 28642-9418
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Country | US
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Telephone | 336-835-6300
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Fax | 336-835-4761
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Authorized Official
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Title or Position | OFFICER
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Name | DR. EVAN A BALLARD
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Credential | M.D.
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Telephone | 336-835-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 40345
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License Number State | NC
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