MEDICARE: DR. BENSON WAYNE TAPLEY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	031337	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	031337	OTHER	GA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1356324859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENSON WAYNE TAPLEY D.O.

Provider Business Mailing Address
First Line	:	125 MEMORIAL DR
Second Line	:	P.O. BOX 890
City	:	REIDSVILLE
State	:	GA
Zip	:	30453-4641
Country	:	US
Telephone Number	:	912-557-3434
Fax Number	:	912-557-6760

Provider Business Practice Location Address
First Line	:	125 MEMORIAL DR
Second Line	:
City	:	REIDSVILLE
State	:	GA
Zip	:	30453-4641
Country	:	US
Telephone Number	:	912-557-3434
Fax Number	:	912-557-6760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. BENSON WAYNE TAPLEY D.O.” Practice Location

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