Provider Demographics
NPI:1700834926
Name:BALLARD, WILEY PERRY III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILEY
Middle Name:PERRY
Last Name:BALLARD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1800 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2538
Mailing Address - Country:US
Mailing Address - Phone:404-350-9853
Mailing Address - Fax:
Practice Address - Street 1:1800 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 775 AND 800
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318
Practice Address - Country:US
Practice Address - Phone:404-350-9853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30265207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD47387Medicare UPIN