Provider Demographics
NPI:1548972128
Name:BALL, JOHNATHON MICHAEL
Entity type:Individual
Prefix:
First Name:JOHNATHON
Middle Name:MICHAEL
Last Name:BALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-9720
Mailing Address - Country:US
Mailing Address - Phone:681-733-0497
Mailing Address - Fax:
Practice Address - Street 1:73 MAYFAIR DR
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150-9720
Practice Address - Country:US
Practice Address - Phone:681-733-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant