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General NPI Number Information
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NPI Number | 1790808848
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Entity Type | Individual
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Provider Name | BENJAMIN P. DEBELAK D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 253 W MAIN ST
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City | GALLATIN
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State | TN
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Zip | 37066-3290
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Country | US
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Telephone | 615-826-7171
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | FORTSON
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State | GA
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Zip | 31808-0370
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Country | US
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Telephone |
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Fax | 706-494-3008
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 2014-00194
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 3817
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2014-00194
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License Number State | NC
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