Individual
CHARLES ELLIS BALENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
315 DEADERICK ST STE 1550, NASHVILLE, TN 37238-3003
(615) 521-4380
(615) 521-4380
Mailing address
100 HIGGINSON PL N, GALLATIN, TN 37066-6086
(615) 521-4380
Taxonomy
Speciality
Code
Description
License number
State
246QL0900X
Laboratory Management Specialist/Technologist
Primary
44D2125377
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44D2125377
LICENSURE/LAB (CMS)
TN
Enumeration date
11/17/2017
Last updated
11/17/2017
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