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General NPI Number Information
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NPI Number | 1164936878
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Entity Type | Individual
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Provider Name | CHARLES ELLIS BALENTINE
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Gender | Male
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 315 DEADERICK ST STE 1550
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City | NASHVILLE
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State | TN
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Zip | 37238-3003
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Country | US
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Telephone | 615-521-4380
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Fax | 615-521-4380
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Provider Business Mailing Address
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Address Line | 100 HIGGINSON PL N
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City | GALLATIN
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State | TN
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Zip | 37066-6086
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Country | US
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Telephone | 615-521-4380
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Fax |
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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 | 246QL0900X
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Taxonomy Name | Laboratory Management Specialist/Technologist
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License Number | 44D2125377
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License Number State | TN
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