Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 068028 | GA |
N | 207Q00000X | Family Doctor | LL31801 | SC |
NPI | 1003044199 |
---|---|
Provider Name | Benjamin R Hess |
First Address | Griffin, GA 30223-1276 |
Second Address | Tifton, GA 31794-2749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2009 |
Last Update Date | 11/11/2020 |