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General NPI Number Information
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NPI Number | 1053087155
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Entity Type | Individual
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Provider Name | BENJAMIN PALMER SCURRY PA
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Gender | Male
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 1799 BRIARCLIFF RD NE STE Q1
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City | ATLANTA
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State | GA
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Zip | 30306-2142
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Country | US
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Telephone | 770-772-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 4840 GUERRY DR
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City | MACON
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State | GA
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Zip | 31210-4104
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Country | US
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Telephone | 478-461-0564
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1179471
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License Number State | GA
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