Provider Demographics
NPI:1598717407
Name:THOMAS, BENJAMIN FRANKLIN III (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FRANKLIN
Last Name:THOMAS
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:PO BOX 71367
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-1367
Mailing Address - Country:US
Mailing Address - Phone:229-435-0525
Mailing Address - Fax:229-434-9827
Practice Address - Street 1:2311 LAKE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:334-749-8303
Practice Address - Fax:334-745-5243
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008758207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51098572THOOtherBLUE CROSS & BLUE SHIELD
AL51032695THOOtherBLUE CROSS & BLUE SHIELD
AL51035558THOOtherBLUE CROSS & BLUE SHIELD
AL000098572Medicaid
AL000032695Medicaid
AL000035558Medicaid
AL000098572Medicaid
AL51098572THOOtherBLUE CROSS & BLUE SHIELD
AL51035558THOMedicare ID - Type Unspecified