Provider Demographics
NPI:1578550760
Name:NEELY, BEN B (MD)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:B
Last Name:NEELY
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:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-0626
Mailing Address - Country:US
Mailing Address - Phone:912-526-6479
Mailing Address - Fax:912-526-8878
Practice Address - Street 1:112 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-1179
Practice Address - Country:US
Practice Address - Phone:912-526-6479
Practice Address - Fax:912-526-8878
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA010065254OtherRAILROAD MEDICARE
GA000012449AMedicaid
D40743Medicare UPIN
GA010065254OtherRAILROAD MEDICARE
GA110249150BMedicare ID - Type Unspecified