Provider Demographics
NPI:1992202840
Name:OLIVER, BENJAMIN TRAVANTA
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:TRAVANTA
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 POINT NORTH PL
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2644
Mailing Address - Country:US
Mailing Address - Phone:706-272-4127
Mailing Address - Fax:706-279-3969
Practice Address - Street 1:302 POINT NORTH PL
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2644
Practice Address - Country:US
Practice Address - Phone:706-272-4127
Practice Address - Fax:706-279-3969
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant