Individual
BALA AMMISETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2300 RAMSEY ST, FAYETTEVILLE, NC 28301-3856
(910) 488-2120
Mailing address
2300 RAMSEY ST, FAYETTEVILLE, NC 28301-3856
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD442146
PA
Other
Enumeration date
03/11/2009
Last updated
11/14/2011
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