Healthcare Provider Details

I. General information

NPI: 1922021724
Provider Name (Legal Business Name): BENJAMIN S ULMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/22/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST DEPT OF
AUGUSTA GA
30912-6302
US

IV. Provider business mailing address

P O BOX 7397
AIKEN SC
29804-7397
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3871
  • Fax:
Mailing address:
  • Phone: 336-553-1659
  • Fax: 336-553-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number15455
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number15455
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: