Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4005-18 | MS |
Y | 213EG0000X | General Practice | 4005-18 | MS |
NPI | 1003309311 |
---|---|
Provider Name | Dr. James Keith Ballard JR. |
First Address | Brookhaven, MS 39601-2640 |
Second Address | Brookhaven, MS 39601-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 11/06/2018 |