Provider Demographics
NPI:1356324859
Name:TAPLEY, BENSON WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:BENSON
Middle Name:WAYNE
Last Name:TAPLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MEMORIAL DR
Mailing Address - Street 2:P.O. BOX 890
Mailing Address - City:REIDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30453-4641
Mailing Address - Country:US
Mailing Address - Phone:912-557-3434
Mailing Address - Fax:912-557-6760
Practice Address - Street 1:125 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-4641
Practice Address - Country:US
Practice Address - Phone:912-557-3434
Practice Address - Fax:912-557-6760
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA031337OtherMEDICAL LICENSE
GA031337OtherMEDICAL LICENSE
GA08BBTDMMedicare ID - Type Unspecified