Provider Demographics
NPI:1679222723
Name:WELCH, BENJAMIN LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LAWRENCE
Last Name:WELCH
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 1:743 SPRING ST NE REAR 710
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3899
Mailing Address - Country:US
Mailing Address - Phone:770-219-8730
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE REAR 710
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3899
Practice Address - Country:US
Practice Address - Phone:770-219-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA982932084P0800X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry