Most Relevant Information
Provider Data
| NPI Number: | 1003647363 |
| Provider Name: | SHANNON BALLARD |
| Entity Type: | Individual |
| Taxonomy Code: | 3747A0650X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/09/2024 |
| Last Updated: | 08/09/2024 |
Provider Practice Location
4800 TREVETT CIR
WINTERVILLE
NC
285909778
Practice Location Phone/Fax
| Phone: | 9198090442 |
| Fax: |
Provider Mailing Location
4800 TREVETT CIR
WINTERVILLE
NC
285909778
Provider Mailing Phone/Fax
| Phone: | 9198090442 |
| Fax: |