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General NPI Number Information
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NPI Number | 1649427436
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Entity Type | Organization
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Legal Business Name | CAROLYN O. BALLANTINE, MD. PLLC
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 1709 LEGION RD SUITE 224
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City | CHAPEL HILL
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State | NC
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Zip | 27517-2375
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Country | US
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Telephone | 919-593-5548
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Fax | 919-929-8900
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Provider Business Mailing Address
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Address Line | 1709 LEGION RD SUITE 224
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City | CHAPEL HILL
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State | NC
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Zip | 27517-2375
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Country | US
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Telephone | 919-593-5548
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Fax | 919-929-8900
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Authorized Official
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Title or Position | SOLE MEMBER/ORGANIZER
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Name | DR. CAROLYN OATES BALLANTINE
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Credential | MD
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Telephone | 919-593-5548
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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 | 200201134
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License Number State | NC
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