Individual
MR. LAURENCE HAVENS BALLOU JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1011 N FRASER ST, GEORGETOWN, SC 29440-2848
(843) 527-3428
(843) 546-8216
Mailing address
1011 N FRASER ST, GEORGETOWN, SC 29440-2848
(843) 527-3428
(843) 546-8216
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
10488
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104880
—
SC
Enumeration date
12/08/2005
Last updated
01/15/2014
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