Provider Demographics
NPI:1780627380
Name:ALLEN, BENJAMIN G (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:G
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:134 ANSLEY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1639
Mailing Address - Country:US
Mailing Address - Phone:706-864-5934
Mailing Address - Fax:706-864-4912
Practice Address - Street 1:134 ANSLEY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1639
Practice Address - Country:US
Practice Address - Phone:706-864-5934
Practice Address - Fax:706-864-4912
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC37997208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10637OtherBCBSNC
NC8910637Medicaid
NC2140399Medicare ID - Type Unspecified
NC8910637Medicaid