Provider Demographics
NPI:1669533436
Name:JONESVILLE FAMILY MEDICAL CENTER, PA
Entity type:Organization
Organization Name:JONESVILLE FAMILY MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-835-6300
Mailing Address - Street 1:113 CRUTCHFIELD ST.
Mailing Address - Street 2:P.O. BOX 947
Mailing Address - City:DOBSON
Mailing Address - State:NC
Mailing Address - Zip Code:27017
Mailing Address - Country:US
Mailing Address - Phone:336-386-4452
Mailing Address - Fax:336-386-4569
Practice Address - Street 1:113 CRUTCHFIELD ST.
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017
Practice Address - Country:US
Practice Address - Phone:336-386-4452
Practice Address - Fax:336-386-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty