Provider Demographics
NPI:1124027842
Name:WATSON, BENJAMIN LUTHER (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LUTHER
Last Name:WATSON
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 1:1326 EISENHOWER DR
Mailing Address - Street 2:BLDG. 2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3928
Mailing Address - Country:US
Mailing Address - Phone:912-527-5100
Mailing Address - Fax:912-527-5149
Practice Address - Street 1:1326 EISENHOWER DR
Practice Address - Street 2:BLDG. 2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-527-5100
Practice Address - Fax:912-527-5149
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029118207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000374437FMedicaid
GA681683OtherBCBS
SCG29118Medicaid
D41338Medicare UPIN
GA11BDLDNMedicare PIN