MEDICARE: BALLARD PAIN & WELLNESS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1487040838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALLARD PAIN & WELLNESS, INC.

Provider Business Mailing Address
First Line	:	7067 VETERANS PKWY STE 210
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-5128
Country	:	US
Telephone Number	:	205-405-7348
Fax Number	:	205-338-0550

Provider Business Practice Location Address
First Line	:	7063 VETERANS PKWY
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-5114
Country	:	US
Telephone Number	:	205-338-3301
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GAYLYN M HORNE
Credential	:	MD
Telephone Number	:	205-908-3310

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	04/13/2020

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