Provider Demographics
NPI:1265488191
Name:BENSON, ASHLEY BEASLEY (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BEASLEY
Last Name:BENSON
Suffix:
Gender:F
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:475 HEYWOOD AVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1726
Practice Address - Country:US
Practice Address - Phone:864-699-5020
Practice Address - Fax:864-699-5050
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22226207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC222262Medicaid
SC222262Medicaid
SCH56036Medicare UPIN
SCH560364710Medicare PIN