Provider Demographics
NPI:1134971328
Name:BALLEW, SETH BENJAMIN
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:BENJAMIN
Last Name:BALLEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 FLINT POINTE CIR SW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-6006
Mailing Address - Country:US
Mailing Address - Phone:256-612-8636
Mailing Address - Fax:
Practice Address - Street 1:530 S JACKSON ST RM C1H17
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:256-612-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program