=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972582096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNE FIELDS BALLINGER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4230 HARDING PIKE SUITE 302W
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37205-2013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-292-7708
-----------------------------------------------------
Fax | 615-292-7756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3024 BUSINESS PARK CIR
-----------------------------------------------------
City | GOODLETTSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37072-3132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-851-6033
-----------------------------------------------------
Fax | 615-851-2018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 13853
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------