Healthcare Provider Details

I. General information

NPI: 1417119173
Provider Name (Legal Business Name): BENJAMIN ADAM DENNIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-4501
US

IV. Provider business mailing address

2425 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-4501
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-1700
  • Fax:
Mailing address:
  • Phone: 706-322-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number064024
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: