Provider Demographics
NPI:1225254931
Name:MCCURDY, BENJAMIN ELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ELLIS
Last Name:MCCURDY
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 1:830 KING AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2889
Mailing Address - Country:US
Mailing Address - Phone:706-425-2400
Mailing Address - Fax:706-425-2410
Practice Address - Street 1:830 KING AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2889
Practice Address - Country:US
Practice Address - Phone:706-425-2400
Practice Address - Fax:706-425-2410
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058906207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA373133496AMedicaid
GA511I050215Medicare Oscar/Certification