Provider Demographics
NPI:1336198274
Name:STUDNICKA, BENEDICT R (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:R
Last Name:STUDNICKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:R
Other - Last Name:STUDNICKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 935722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5722
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:114 GATEWAY CORPORATE BLVD STE 330
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9785
Practice Address - Country:US
Practice Address - Phone:803-254-2786
Practice Address - Fax:803-254-9015
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC178195Medicaid
SC178195Medicaid
SCG344360281Medicare PIN