Provider Demographics
NPI:1982768016
Name:MORTON, BENJAMIN DOUGLAS III (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DOUGLAS
Last Name:MORTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4827 WESLEYAN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4116
Mailing Address - Country:US
Mailing Address - Phone:478-477-1804
Mailing Address - Fax:478-477-8235
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-1320
Practice Address - Fax:478-633-1770
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA21558207ZP0102X
NC20940207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA22CDBFQMedicare ID - Type Unspecified
GAE71232Medicare UPIN