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NPI Code Detail

MEDICARE: DR. OLIVER BENTON III M.D.

MEDICARE: DR. OLIVER BENTON III M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician1467TN

General Provider Information

NPI Number : 1386740082
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OLIVER BENTON III M.D.
Provider Business Mailing Address
First Line : 1949 GUNBARREL RD STE 206
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-7133
Country : US
Telephone Number : 423-495-4349
Fax Number : 423-495-4934
Provider Business Practice Location Address
First Line : 1300 CLEVELAND AVE
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37404-2005
Country : US
Telephone Number : 423-756-7860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 08/24/2019

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