Provider Demographics
NPI:1326350653
Name:FERNANDO, BENJAMIN ARJUNA (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ARJUNA
Last Name:FERNANDO
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 1:805 PEACHTREE ST NE
Mailing Address - Street 2:STE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-6009
Mailing Address - Country:US
Mailing Address - Phone:678-904-5611
Mailing Address - Fax:
Practice Address - Street 1:1301 SIGMAN RD
Practice Address - Street 2:SUITE 230
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012
Practice Address - Country:US
Practice Address - Phone:678-609-4912
Practice Address - Fax:678-609-4932
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine