Individual
JEFFREY TIM BALLAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1237 HARDING PL, STE 3100, CHARLOTTE, NC 28204
(704) 373-0212
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-03547
NC
363A00000X
Physician Assistant
PAC1127
ND
Other
Enumeration date
04/10/2007
Last updated
11/20/2024
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