Healthcare Provider Details

I. General information

NPI: 1881328045
Provider Name (Legal Business Name): BENJAMIN SCOTT BLEDSOE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date: 08/09/2023
Reactivation Date: 11/08/2023

III. Provider practice location address

1061 HARMON AVE
FORT STEWART GA
31314-5641
US

IV. Provider business mailing address

1061 HARMON AVE
FORT STEWART GA
31314-5641
US

V. Phone/Fax

Practice location:
  • Phone: 571-802-0394
  • Fax:
Mailing address:
  • Phone: 571-802-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0810008768
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008768
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: