Jonathan Livingston Benjamin
Individual provider Active NPI Driver · Antioch, TN
NPI 1750138574 · NPPES record last updated Apr 30, 2024
Key facts
- NPI
- 1750138574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 094847770 (TN)
- Practice address
- 7602 Gunners Landing Dr
Antioch, TN 37013-3881 - Phone
- (615) 917-7285
- NPI assigned
- Apr 30, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 094847770 | TN | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 094847770 | TN | Yes |
Addresses
Primary practice location
7602 Gunners Landing Dr
Antioch, TN 37013-3881
Mailing address
7602 Gunners Landing Dr
Antioch, TN 37013-3881
Phone (615) 917-7285
Other providers in Antioch, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.