Provider Demographics
NPI:1104890573
Name:HARRIS, BENJAMIN JEPPESON (MD)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:JEPPESON
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3139
Mailing Address - Country:US
Mailing Address - Phone:706-835-2222
Mailing Address - Fax:706-835-2221
Practice Address - Street 1:19 DOCTORS WAY
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512
Practice Address - Country:US
Practice Address - Phone:706-835-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58761207V00000X
GA048425207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151550402Medicaid
GA728259337BMedicaid
GA367867OtherWELLCARE
GA52223338001OtherBCBS
GA728259337CMedicaid
NC5905850Medicaid
GA728259337AMedicaid
GA10077479OtherAMERIGROUP
NC5908360Medicaid
TN4047256Medicaid
GAGRP2364Medicare PIN
TX8D6430Medicare ID - Type Unspecified
TX151550402Medicaid
GA52223338001OtherBCBS
TN4047256Medicaid