MEDICARE: BENJAMIN GOLDEN THOMASSON D.O.

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
1	207X00000X	Orthopaedic Surgery Physician	P9266	TX
2	207X00000X	Orthopaedic Surgery Physician	OS13167	FL
3	207X00000X	Orthopaedic Surgery Physician	5680	OK
4	207X00000X	Orthopaedic Surgery Physician	22603	NH
5	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	OS13167	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396078200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN GOLDEN THOMASSON D.O.

Provider Business Mailing Address
First Line	:	PO BOX 370
Second Line	:
City	:	FORTSON
State	:	GA
Zip	:	31808-0370
Country	:	US
Telephone Number	:	706-324-6661
Fax Number	:

Provider Business Practice Location Address
First Line	:	6775 CHOPRA TER STE 300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-5811
Country	:	US
Telephone Number	:	407-340-0263
Fax Number	:	844-251-4517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	06/29/2022

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Directions to “ BENJAMIN GOLDEN THOMASSON D.O.” Practice Location

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