Provider Demographics
NPI:1124227061
Name:STEPHENS, BENJAMIN MICHAEL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 OLD HIGHWAY 5 N
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-1812
Mailing Address - Country:US
Mailing Address - Phone:334-636-1333
Mailing Address - Fax:
Practice Address - Street 1:220 OLD HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-1812
Practice Address - Country:US
Practice Address - Phone:334-636-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084033367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered