Provider Demographics
NPI:1316590185
Name:JAMES, BENJAMIN (MS-SLP-CCC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:MS-SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-2707
Mailing Address - Country:US
Mailing Address - Phone:706-982-1009
Mailing Address - Fax:
Practice Address - Street 1:3725 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6623
Practice Address - Country:US
Practice Address - Phone:706-868-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009698235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist