Provider Demographics
NPI:1962426551
Name:PLAHTINSKY, BENJAMIN R (PA-C)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:PLAHTINSKY
Suffix:
Gender:M
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 1:2205 MCCALLIE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3230
Mailing Address - Country:US
Mailing Address - Phone:423-493-5220
Mailing Address - Fax:423-493-5228
Practice Address - Street 1:2205 MCCALLIE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3230
Practice Address - Country:US
Practice Address - Phone:423-493-5220
Practice Address - Fax:423-493-5228
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1344363A00000X
TNPA1344207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q43427Medicare UPIN