Provider Demographics
NPI:1194234468
Name:COLSTON, BENJAMIN (PA-C)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:COLSTON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 RIVERCHASE BLVD STE 3200
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0274
Mailing Address - Country:US
Mailing Address - Phone:704-468-0101
Mailing Address - Fax:
Practice Address - Street 1:1656 RIVERCHASE BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-0274
Practice Address - Country:US
Practice Address - Phone:704-468-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant