MEDICARE: DR. BENJAMIN PRESTON KIGHT DO

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	84006	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	93919	SC

General Provider Information

NPI Number	:	1902398829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN PRESTON KIGHT DO

Provider Business Mailing Address
First Line	:	1585 3RD ST
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-5102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 FRONT ST STE 240
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-8140
Country	:	US
Telephone Number	:	854-220-9995
Fax Number	:

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

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	06/18/2025

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