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General NPI Number Information
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NPI Number | 1356367312
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Entity Type | Individual
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Provider Name | NANETTE A BALLARD MD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 1225 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39202-2064
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Country | US
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Telephone | 601-968-3070
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Fax | 601-974-6286
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Provider Business Mailing Address
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Address Line | PO BOX 2121
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City | MEMPHIS
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State | TN
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Zip | 38159-0001
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Country | US
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Telephone | 601-968-3070
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Fax | 601-974-6286
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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 | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | 12147
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License Number State | MS
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