Basic Information
| Provider Information | |||||||||
| NPI: | 1598717407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | FRANKLIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 71367 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317081367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2294350525 | ||||||||
| FaxNumber: | 2294349827 | ||||||||
| Practice Location | |||||||||
| Address1: | 2311 LAKE PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347498303 | ||||||||
| FaxNumber: | 3347455243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 12/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | 00008758 | AL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 51098572THO | 01 | AL | BLUE CROSS & BLUE SHIELD | OTHER | 51032695THO | 01 | AL | BLUE CROSS & BLUE SHIELD | OTHER | 51035558THO | 01 | AL | BLUE CROSS & BLUE SHIELD | OTHER | 000098572 | 05 | AL | MEDICAID | 000032695 | 05 | AL | MEDICAID | 000035558 | 05 | AL | MEDICAID |