MEDICARE: DR. BENJAMIN CARSON BARNARD 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
1	2084P0800X	Psychiatry Physician	021638	GA

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	:	1912075193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN CARSON BARNARD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 14638
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30919-0638
Country	:	US
Telephone Number	:	706-364-3965
Fax Number	:	706-504-3263

Provider Business Practice Location Address
First Line	:	2608 COMMONS BLVD
Second Line	:	SUITE A
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2080
Country	:	US
Telephone Number	:	706-364-3965
Fax Number	:	706-504-3263

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/30/2011

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