Provider Demographics
NPI:1154776813
Name:HARPER, BENJAMIN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:HARPER
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 1:144 BILL CARRUTH PKWY STE 2300
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-3821
Mailing Address - Country:US
Mailing Address - Phone:770-428-4475
Mailing Address - Fax:678-363-8836
Practice Address - Street 1:AU HEALTH MEDICAL CTR
Practice Address - Street 2:1120 FIFTEENTH STREET, BA 8415
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:404-444-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA88872208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program