| Doctor Name: | GARY H BALLARD |
| NPI Number: | 1720022395 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | RN0000063398 |
| Business Practice Address: | 403 Mcbrien Rd East Ridge, TN - 374123223 |
| Business Phone Number: | 4238943589 |
| Business Fax Number: | 4238923378 |
| Mailing Address: | 992 Clift Cave Rd, SODDY DAISY |
| State: | TN |
| Postal Code: | 373795700 |
| Phone Number: | 4233329218 |
| Fax Number: | 4236054704 |
| NPI Enumeration Date: | 06/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN0000063398 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |