Provider Demographics
NPI:1760827331
Name:RENELUS, BENJAMIN DWIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DWIGHT
Last Name:RENELUS
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 1:8901 STONEBRIDGE BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2244
Mailing Address - Country:US
Mailing Address - Phone:943-202-7120
Mailing Address - Fax:
Practice Address - Street 1:8901 STONEBRIDGE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2244
Practice Address - Country:US
Practice Address - Phone:943-202-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0092002207RG0100X
GA76667207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology