Active NPI
Marijean Dale Ballard, ATC
- Athletic Trainer
- Deatsville, AL
National Provider Identifier
1609811512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 610
- Practice address
- 289 Summertime Pkwy
Deatsville, AL 36022-5371 - Phone
- (205) 601-5160
- Fax
- (205) 378-1920
- NPI assigned
- Jun 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 610 | AL | Primary |
Addresses
Primary practice location
289 Summertime Pkwy
Deatsville, AL 36022-5371
Mailing address
289 Summertime Pkwy
Deatsville, AL 36022-5371
Phone (205) 601-5160
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 610 | AL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408060800000",
"number": "1609811512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "289 SUMMERTIME PKWY",
"city": "DEATSVILLE",
"state": "AL",
"postal_code": "360225371",
"telephone_number": "205-601-5160",
"fax_number": "205-378-1920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "289 SUMMERTIME PKWY",
"city": "DEATSVILLE",
"state": "AL",
"postal_code": "360225371",
"telephone_number": "205-601-5160",
"fax_number": "205-378-1920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLARD",
"first_name": "MARIJEAN",
"middle_name": "DALE",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-17",
"last_updated": "2014-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AL",
"license": "610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deatsville, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.