Basic Information
| Provider Information | |||||||||
| NPI: | 1538377502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOOLE | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2835 BRANDYWINE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303415510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042562593 | ||||||||
| FaxNumber: | 7704889408 | ||||||||
| Practice Location | |||||||||
| Address1: | 2709 MEREDYTH DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317070222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042562593 | ||||||||
| FaxNumber: | 7704889408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD.28609 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | P3088 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 63744 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD.28609 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | 063744 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 111017 | 05 | AL | MEDICAID | 515-99848 | 01 | AL | BCBS | OTHER | 515-98367 | 01 | AL | BCBS | OTHER | 110478 | 05 | AL | MEDICAID | 1538377502 | 01 | AL | TRICARE SOUTH | OTHER |