Provider Demographics
NPI:1003831710
Name:RAWLS, BENJAMIN ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ELLIS
Last Name:RAWLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD FL 5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4210
Practice Address - Country:US
Practice Address - Phone:864-455-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19830207R00000X, 208M00000X
NC200100936208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC198306Medicaid
NCP00280389OtherRAILROAD MEDICARE
NC89129NTMedicaid
SCP01586733OtherMEDICARE RR PIN
NC129NTOtherBCBS
NCP00280389OtherRAILROAD MEDICARE
SC198306Medicaid
G95024Medicare UPIN
SCSC29325773Medicare PIN
SCSC29327579Medicare PIN