Provider Demographics
NPI:1649421462
Name:F B BENSON III MD PC
Entity Type:Organization
Organization Name:F B BENSON III MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-423-7065
Mailing Address - Street 1:824 6TH AVE SE STE B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3022
Mailing Address - Country:US
Mailing Address - Phone:256-350-4782
Mailing Address - Fax:256-350-5508
Practice Address - Street 1:824 6TH AVE SE STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3022
Practice Address - Country:US
Practice Address - Phone:256-350-4782
Practice Address - Fax:256-350-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7906207P00000X, 207QA0401X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000031365Medicaid
AL1154377828OtherBCBC OF ALABAMA
AL1154377828OtherRAILROAD MEDICARE
ALC69943Medicare UPIN
AL00031365Medicare PIN