Healthcare Provider Details

I. General information

NPI: 1982607180
Provider Name (Legal Business Name): PAUL MICHAEL BENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 NORTH STATE OF FRANKLIN ACCESS ROAD
JOHNSON CITY TN
37604
US

IV. Provider business mailing address

1009 NORTH STATE OF FRANKLIN ACCESS ROAD
JOHNSON CITY TN
37604
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-7546
  • Fax: 423-929-7968
Mailing address:
  • Phone: 423-929-7546
  • Fax: 423-929-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number38501
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number38501
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: