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NPI Code Detail

MEDICARE: BENJAMIN PERRY FOLK III M.D.

MEDICARE: BENJAMIN PERRY FOLK III M.D.
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
1174400000XSpecialist10931MS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1060024546OTHERMSRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
24376234OTHERMSAETNA PIN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629010012
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN PERRY FOLK III M.D.
Provider Business Mailing Address
First Line : 1502 S COLORADO ST
Second Line :
City : GREENVILLE
State : MS
Zip : 38703-7219
Country : US
Telephone Number : 662-332-9872
Fax Number : 662-378-0290
Provider Business Practice Location Address
First Line : 1502 S COLORADO ST
Second Line :
City : GREENVILLE
State : MS
Zip : 38703-7219
Country : US
Telephone Number : 662-332-9872
Fax Number : 662-378-0290
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 01/03/2020

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