Collierville Medical Assoc Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

007768 Issued in TN

Legal business name

COLLIERVILLE MEDICAL ASSOC INC

Practice address

151 N Main St
Collierville, TN 38017-2670

Phone

(901) 853-4747

Fax

(901) 853-6716

NPI assigned

Sep 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert Cheatham Ballard, MD

Title

President

Phone

(901) 853-4747

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1063608271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N MAIN ST",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172670",
            "telephone_number": "901-853-4747",
            "fax_number": "901-853-6716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N MAIN ST",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172670",
            "telephone_number": "901-853-4747",
            "fax_number": "901-853-6716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIERVILLE MEDICAL ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "CHEATHAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-853-4747",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "007768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Collierville Orthopedics and
• Collierville Pediatrics, LLC
• Collierville Vision Center PLLC

• Primary Care Clinic/Center in Collierville, TN
• Providers in Collierville, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.