Healthcare Provider Details

I. General information

NPI: 1760640734
Provider Name (Legal Business Name): BENJAMIN BERYL BARDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 JOHNSON FERRY RD STE 200
MARIETTA GA
30068-2764
US

IV. Provider business mailing address

4800 OLDE TOWNE PKWY STE 430
MARIETTA GA
30068-4357
US

V. Phone/Fax

Practice location:
  • Phone: 770-977-7777
  • Fax: 404-355-2136
Mailing address:
  • Phone: 770-321-1001
  • Fax: 770-321-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number30755
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD26095
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number052544
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number076634
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: