Provider Demographics
NPI:1659649606
Name:BALL, NATHAN A (NP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
Last Name:BALL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SCRANTON CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0540
Mailing Address - Country:US
Mailing Address - Phone:912-262-2347
Mailing Address - Fax:912-262-3036
Practice Address - Street 1:1716 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6417
Practice Address - Country:US
Practice Address - Phone:912-262-3236
Practice Address - Fax:912-262-0813
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN176462363L00000X
GA2011008422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily