Provider Demographics
NPI:1679602130
Name:BALLARD, WILLIAM EVAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EVAN
Last Name:BALLARD
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 1:4000 S SWAIM STREET EXT
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642-9418
Mailing Address - Country:US
Mailing Address - Phone:336-835-6300
Mailing Address - Fax:336-835-4761
Practice Address - Street 1:4000 S SWAIM STREET EXT
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642-9418
Practice Address - Country:US
Practice Address - Phone:336-835-6300
Practice Address - Fax:336-835-4761
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911226Medicaid
NC9355234OtherAETNA
NC1504EOtherBCBSNC
NC5911226Medicaid
NC1504EOtherBCBSNC