Provider Demographics
NPI:1922369123
Name:FRIDAY, BENJAMIN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:FRIDAY
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:12230 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-1845
Practice Address - Country:US
Practice Address - Phone:864-472-2144
Practice Address - Fax:864-472-4696
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255469207Q00000X
SC52700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCF2185121OtherMEDICARE PIN
SCSCF218J577OtherMEDICARE PIN
SC527004Medicaid
SCSCF2186067OtherMEDICARE PIN
SCSCF2186084OtherMEDICARE PIN
SCSCF2185213OtherMEDICARE PIN