Provider Demographics
NPI:1558459933
Name:BENTON, GEORGE RUFFIN III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RUFFIN
Last Name:BENTON
Suffix:III
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 1:220 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-4377
Mailing Address - Country:US
Mailing Address - Phone:828-692-4289
Mailing Address - Fax:828-696-1794
Practice Address - Street 1:29 W FRENCH BROAD ST STE 202
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4773
Practice Address - Country:US
Practice Address - Phone:828-883-5550
Practice Address - Fax:828-883-5525
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01-70389OtherUNITED HEALTHCARE
NC15071OtherBLUE CROSS BLUE SHIELD
NC8915071Medicaid
NC561852981EOtherCIGNA
NC0637660001OtherPALMETTO GOVERNMENT SERVI
NC110012027OtherRAILROAD MEDICARE
NC15071OtherBLUE CROSS BLUE SHIELD
NC201719AMedicare ID - Type Unspecified