Provider Demographics
NPI:1235237546
Name:BENDER, JAY B (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:B
Last Name:BENDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4907
Mailing Address - Country:US
Mailing Address - Phone:678-297-7588
Mailing Address - Fax:678-297-7587
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:678-297-7588
Practice Address - Fax:678-297-7587
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0497872081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA049787OtherLICENSE
GAH42962Medicare UPIN
25BBFRZMedicare PIN