Basic Information
| Provider Information | |||||||||
| NPI: | 1609432699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDIFER | ||||||||
| FirstName: | BENJAMIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 WELLNESS WAY | ||||||||
| Address2: | SUITE 7230 | ||||||||
| City: | ST. SIMONS ISLAND | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048289783 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 WELLNESS WAY | ||||||||
| Address2: | SUITE 7230 | ||||||||
| City: | ST. SIMONS ISLAND | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048289783 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2019 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 92625 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.