Provider Demographics
NPI:1356880025
Name:BALLARD, RANDALL
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:
Last Name:BALLARD
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 1:935 MARIETTA ST NW
Mailing Address - Street 2:29
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-0527
Mailing Address - Country:US
Mailing Address - Phone:678-663-8714
Mailing Address - Fax:
Practice Address - Street 1:935 MARIETTA ST NW
Practice Address - Street 2:29
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0527
Practice Address - Country:US
Practice Address - Phone:678-663-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other