Individual provider Active NPI

Benjamin Palmer Scurry, PAC

  • Physician Assistant
  • Atlanta, GA
National Provider Identifier
1053087155
Registry record updated Sep 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10817 Issued in GA
Practice address
1799 Briarcliff Rd NE Ste Q1
Atlanta, GA 30306-2142
Phone
(770) 772-1830
NPI assigned
Aug 18, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10817 GA Primary

Addresses

Primary practice location

1799 Briarcliff Rd NE Ste Q1
Atlanta, GA 30306-2142

Mailing address

4800 Olde Towne Pkwy Ste 150a
Marietta, GA 30068-4357
Phone (770) 509-1025

Other practice location 1

4800 Olde Towne Pkwy Ste 150A
Marietta, GA 30068-4357
Phone (770) 509-1025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220523000493 GA Practitioner - Physician Assistant 7113304668 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians

Practice addresses (Care Compare)

2292 Peachtree Rd
Atlanta, GA 30309-1147
Phone (404) 382-9941

285 Ridgewalk Pkwy
Suite 108
Woodstock, GA 30188-4964
Phone (470) 276-9505

3345 Cobb Pkwy NW
Suite 800
Acworth, GA 30101-8346
Phone (678) 919-7200

500 Nathan Dean Blvd
Suite 105
Dallas, GA 30157-4911
Phone (470) 624-6793

7820 Hickory Flat Hwy
Woodstock, GA 30188-2099
Phone (404) 353-5181

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1179471GAMDPhysician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789084800000",
    "number": "1053087155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 OLDE TOWNE PKWY STE 150A",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684357",
            "telephone_number": "770-509-1025",
            "fax_number": "770-509-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1799 BRIARCLIFF RD NE STE Q1",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303062142",
            "telephone_number": "770-772-1830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4800 Olde Towne Pkwy Ste 150A",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300684357",
            "country_code": "US",
            "telephone_number": "770-509-1025",
            "fax_number": "770-509-1884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCURRY",
        "first_name": "BENJAMIN",
        "middle_name": "PALMER",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-18",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.