Provider Demographics
NPI:1235199092
Name:BALL, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:BALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12-A FARMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7755
Mailing Address - Country:US
Mailing Address - Phone:843-573-2255
Mailing Address - Fax:843-573-2291
Practice Address - Street 1:12-A FARMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7755
Practice Address - Country:US
Practice Address - Phone:843-573-2255
Practice Address - Fax:843-573-2291
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC137943Medicaid
SCD90547Medicare UPIN
SC137943Medicaid