Provider Demographics
NPI:1306714043
Name:INGRAM, BENJIE TYRONE
Entity type:Individual
Prefix:
First Name:BENJIE
Middle Name:TYRONE
Last Name:INGRAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 39TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7108
Mailing Address - Country:US
Mailing Address - Phone:762-409-6292
Mailing Address - Fax:
Practice Address - Street 1:1018 39TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7108
Practice Address - Country:US
Practice Address - Phone:762-409-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)