Provider Demographics
NPI:1801016134
Name:FLEMING, BENJAMIN K (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:K
Last Name:FLEMING
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4553 CREEK FOREST CT
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047
Mailing Address - Country:US
Mailing Address - Phone:770-717-0158
Mailing Address - Fax:
Practice Address - Street 1:1315 JESSE JEWELL PARKWAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3822
Practice Address - Country:US
Practice Address - Phone:770-219-6520
Practice Address - Fax:770-219-6521
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108143AMedicaid
GA202I976846OtherMEDICARE PTAN