Provider Demographics
NPI:1053087155
Name:SCURRY, BENJAMIN PALMER (PA)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:PALMER
Last Name:SCURRY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 GUERRY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4104
Mailing Address - Country:US
Mailing Address - Phone:478-461-0564
Mailing Address - Fax:
Practice Address - Street 1:1799 BRIARCLIFF RD NE STE Q1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2142
Practice Address - Country:US
Practice Address - Phone:770-772-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1179471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant