Provider Demographics
NPI:1942938311
Name:SAMANTHA BALL DO LLC
Entity Type:Organization
Organization Name:SAMANTHA BALL DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-985-5133
Mailing Address - Street 1:3619 BRASELTON HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4668
Mailing Address - Country:US
Mailing Address - Phone:770-513-8882
Mailing Address - Fax:770-513-3545
Practice Address - Street 1:3619 BRASELTON HWY STE 103
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4668
Practice Address - Country:US
Practice Address - Phone:770-513-8882
Practice Address - Fax:770-513-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care