Provider Demographics
NPI:1154437598
Name:JONESVILLE FAMILY MEDICAL CENTER, P.A.
Entity type:Organization
Organization Name:JONESVILLE FAMILY MEDICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-835-6300
Mailing Address - Street 1:4000 S SWAIM STREET EXT
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642-9418
Mailing Address - Country:US
Mailing Address - Phone:336-835-6300
Mailing Address - Fax:336-835-4761
Practice Address - Street 1:4000 S SWAIM STREET EXT
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642-9418
Practice Address - Country:US
Practice Address - Phone:336-835-6300
Practice Address - Fax:336-835-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0178AOtherBCBSNC
NC890178AMedicaid
NC01916OtherBCBSNC
NC8901916Medicaid
NC1332Medicare ID - Type Unspecified
NC8901916Medicaid