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General NPI Number Information
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NPI Number | 1497240824
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Entity Type | Individual
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Provider Name | BENJAMIN PAUL PA-C, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 327 MOCKSVILLE AVE
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City | SALISBURY
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State | NC
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Zip | 28144-3327
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Country | US
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Telephone | 704-210-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 2992 HALLIE BURNETTE RD
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City | OXFORD
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State | NC
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Zip | 27565-9597
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Country | US
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Telephone | 252-431-4062
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0010-13435
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-13435
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License Number State | NC
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