Basic Information
Provider Information
NPI: 1639253677
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BALLARD
FirstName: SANDRA
MiddleName: LEE
NamePrefix: MRS.
NameSuffix:  
Credential: RN CRNI
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 JOHNSON FERRY RD NE
Address2: NORTHSIDE HOSPITAL
City: ATLANTA
State: GA
PostalCode: 303421606
CountryCode: US
TelephoneNumber: 4048518000
FaxNumber:  
Practice Location
Address1: 413 OLD JOHNSON RD
Address2:  
City: MURPHY
State: NC
PostalCode: 289067775
CountryCode: US
TelephoneNumber: 8286444591
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/25/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WI0500XRN138282GAY Nursing Service ProvidersRegistered NurseInfusion Therapy

No ID Information.


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