Provider Demographics
NPI:1457335549
Name:TOWE, BENJAMIN F (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:F
Last Name:TOWE
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 1:210 OAK ST N
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5139
Mailing Address - Country:US
Mailing Address - Phone:706-228-1677
Mailing Address - Fax:706-228-5319
Practice Address - Street 1:210 OAK ST N
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5139
Practice Address - Country:US
Practice Address - Phone:706-228-1677
Practice Address - Fax:706-228-5319
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00232064QMedicaid
GAD41252Medicare UPIN
GA08BBSHCMedicare ID - Type UnspecifiedMCARE PROVIDER NUMBER