Laurence Havens Ballou Jr., MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

10488 Issued in SC

Practice address

1011 N Fraser St
Georgetown, SC 29440-2848

Phone

(843) 527-3428

Fax

(843) 546-8216

NPI assigned

Dec 8, 2005

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Waccamaw Endoscopy Center, LLC

  • Clinic/Center
  • Georgetown, SC
  • NPI 1033251160
  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 15, 2014.

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389744000000",
    "number": "1962487306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402848",
            "telephone_number": "843-527-3428",
            "fax_number": "843-546-8216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 N FRASER ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294402848",
            "telephone_number": "843-527-3428",
            "fax_number": "843-546-8216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALLOU",
        "first_name": "LAURENCE",
        "middle_name": "HAVENS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-08",
        "last_updated": "2014-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "SC",
            "license": "10488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104880",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Associated Pathologists LLC
• Atalaya Fits Boutique LLC
• Motaz Baibars, M.D.
• Sachi Baird
• Brandy P Baker, P.A.
• Lyle Barker, D.C.
• Amanda Denise Barron
• Julia Marie Barton Hulsey, MD
• Jennifer Mary Barton, CPSS
• Bay Microsurgical Unit

• All providers in Georgetown, SC
• Gastroenterology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 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.

Verify at the official NPI Registry.