Basic Information
| Provider Information | |||||||||
| NPI: | 1700843802 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALL | ||||||||
| FirstName: | ALTON | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 ACKERMAN 3RD FLOOR | ||||||||
| Address2: | PO BOX 183103 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432183103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142932160 | ||||||||
| FaxNumber: | 6142936479 | ||||||||
| Practice Location | |||||||||
| Address1: | 86 NORTH WILSON ROAD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142933500 | ||||||||
| FaxNumber: | 6142932545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35050008 | OH | X | Allopathic & Osteopathic Physicians | Family Medicine | 2083X0100X | 35050008 | OH | X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0760618 | 05 | OH | MEDICAID |