Provider Demographics
NPI:1912226945
Name:BALLARD, BRENT G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:G
Last Name:BALLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2775 US HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-5263
Mailing Address - Country:US
Mailing Address - Phone:205-487-2066
Mailing Address - Fax:205-487-0383
Practice Address - Street 1:2775 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5263
Practice Address - Country:US
Practice Address - Phone:205-487-2066
Practice Address - Fax:205-487-0383
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL31218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine