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1568458636

NPI Code Detail

MEDICARE: DR. BENJAMIN GRODIN MD

MEDICARE: DR. BENJAMIN GRODIN MD

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	207L00000X	Anesthesiology Physician	054570	GA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	054570	GA
3	207L00000X	Anesthesiology Physician	ME89281	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568458636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN GRODIN MD

Provider Business Mailing Address
First Line	:	PO BOX 116171
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-6171
Country	:	US
Telephone Number	:	800-919-1190
Fax Number	:	706-737-2271

Provider Business Practice Location Address
First Line	:	3000 HOSPITAL BLVD
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4915
Country	:	US
Telephone Number	:	770-751-2500
Fax Number	:	770-751-2609

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	12/13/2019

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Directions to “ DR. BENJAMIN GRODIN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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