Provider Demographics
NPI:1104827252
Name:BALLENGER, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:BALLENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24 SEAGRASS LN
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-3853
Mailing Address - Country:US
Mailing Address - Phone:843-886-0907
Mailing Address - Fax:843-886-4093
Practice Address - Street 1:192 E BAY ST
Practice Address - Street 2:STE 204
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-2171
Practice Address - Country:US
Practice Address - Phone:843-937-5950
Practice Address - Fax:843-937-5951
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC116502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry