=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881677847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL E BALLINGER PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 02/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 KINGTON LANE
-----------------------------------------------------
City | CHICKAMAUGA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-375-9400
-----------------------------------------------------
Fax | 706-375-9491
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7305 JARNIGAN ROAD SUITE 230
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-4874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-495-4345
-----------------------------------------------------
Fax | 423-495-4934
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 001418
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------