Provider Demographics
NPI:1700247855
Name:CARETIME MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:CARETIME MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEIANNE
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:662-597-2019
Mailing Address - Street 1:1506 HIGHWAY 278 E STE A
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5906
Mailing Address - Country:US
Mailing Address - Phone:662-597-2019
Mailing Address - Fax:
Practice Address - Street 1:1506 HIGHWAY 278 E STE A
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5906
Practice Address - Country:US
Practice Address - Phone:662-597-2019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty