Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 17712 | TN |
Y | 111NI0900X | Internist | 17712 | TN |
N | 207RH0002X | Hospice and Palliative Medicine | 17712 | TN |
NPI | 1316054133 |
---|---|
Provider Name | Ben A Gardner |
First Address | Columbia, TN 38401-4659 |
Second Address | Columbia, TN 38401-4659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3024573 | (05) | TN |
3154189 | BCBSTN (01) | TN |
3710089 | (05) | TN |
A98895 | (02) | TN |