Provider Demographics
NPI:1497775548
Name:BENTON, JODIE B (MD)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:B
Last Name:BENTON
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 1:800 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1620
Mailing Address - Country:US
Mailing Address - Phone:205-271-1600
Mailing Address - Fax:
Practice Address - Street 1:800 SAINT VINCENTS DR
Practice Address - Street 2:NORTH TOWER SUITE 600
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1620
Practice Address - Country:US
Practice Address - Phone:205-271-1600
Practice Address - Fax:205-271-3167
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24407207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009962235Medicaid
AL009962235Medicaid
ALI12856Medicare UPIN