Provider Demographics
NPI:1396078200
Name:THOMASSON, BENJAMIN GOLDEN (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:GOLDEN
Last Name:THOMASSON
Suffix:
Gender:M
Credentials:DO
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 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:706-324-6661
Mailing Address - Fax:
Practice Address - Street 1:6775 CHOPRA TER STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5811
Practice Address - Country:US
Practice Address - Phone:407-340-0263
Practice Address - Fax:844-251-4517
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9266207X00000X
FLOS13167207X00000X, 207XX0005X
OK5680207X00000X
NH22603207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery