Provider Demographics
NPI:1053409201
Name:BALLARD, JULIA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ELIZABETH
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:BALLARD
Other - Last Name:HARALSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19599
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30325-0599
Mailing Address - Country:US
Mailing Address - Phone:404-605-3297
Mailing Address - Fax:
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021637207P00000X
GA21637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000229765EMedicaid
GA93BDWBGMedicare ID - Type Unspecified
GA000229765EMedicaid