Individual
KEVIN M. BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
790 CHURCH ST NE, SUITE 400, MARIETTA, GA 30060-7282
(770) 952-8899
Mailing address
PO BOX 3157, INDIANAPOLIS, IN 46206-3157
(855) 871-1526
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006171
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112208A
—
GA
05
—
003112208B
—
GA
Enumeration date
08/08/2011
Last updated
03/10/2017
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