Provider Demographics
NPI:1528441979
Name:BALL, MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1382
Mailing Address - Country:US
Mailing Address - Phone:855-675-5200
Mailing Address - Fax:855-675-5212
Practice Address - Street 1:85 TECHNOLOGY PKWY NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1382
Practice Address - Country:US
Practice Address - Phone:855-675-5200
Practice Address - Fax:855-675-5212
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA202215095183500000X
GARPH017924183500000X
AL18172183500000X
NE15444183500000X
OK16979183500000X
MI5302044860183500000X
TX59326183500000X
WVRP0009700183500000X
MST14582183500000X
ARPD13776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist