Provider Demographics
NPI:1619330875
Name:HAYES, BENJAMIN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:HAYES
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 1:500 MEDICAL CENTER BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3332
Mailing Address - Country:US
Mailing Address - Phone:678-312-0500
Mailing Address - Fax:678-312-0525
Practice Address - Street 1:500 MEDICAL CENTER BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3332
Practice Address - Country:US
Practice Address - Phone:678-312-0500
Practice Address - Fax:678-312-0525
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA84866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program