Provider Demographics
NPI:1760640734
Name:BARDEN, BENJAMIN BERYL (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BERYL
Last Name:BARDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4800 OLDE TOWNE PKWY
Mailing Address - Street 2:STE 430
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4357
Mailing Address - Country:US
Mailing Address - Phone:770-321-1001
Mailing Address - Fax:770-321-8290
Practice Address - Street 1:1163 JOHNSON FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2764
Practice Address - Country:US
Practice Address - Phone:770-977-7777
Practice Address - Fax:404-355-2136
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30755207X00000X
MEMD26095207X00000X
CT052544207XX0005X
GA076634207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I208317Medicare PIN
RES000Medicare UPIN