Provider Demographics
NPI:1912075193
Name:BARNARD, BENJAMIN CARSON (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CARSON
Last Name:BARNARD
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 14638
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-0638
Mailing Address - Country:US
Mailing Address - Phone:706-364-3965
Mailing Address - Fax:706-504-3263
Practice Address - Street 1:2608 COMMONS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2080
Practice Address - Country:US
Practice Address - Phone:706-364-3965
Practice Address - Fax:706-504-3263
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0216382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA615325267EMedicaid
GA26BDJNLMedicare ID - Type Unspecified