Basic Information
Provider Information
NPI: 1053638148
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BENSON
FirstName: LEVI
MiddleName: POTTER
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1400 ROSA L PARKS BLVD
Address2: APT 130
City: NASHVILLE
State: TN
PostalCode: 372082565
CountryCode: US
TelephoneNumber: 7162440531
FaxNumber:  
Practice Location
Address1: 4321 CAROTHERS PKWY
Address2:  
City: FRANKLIN
State: TN
PostalCode: 370675909
CountryCode: US
TelephoneNumber: 6154356690
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/28/2010
LastUpdateDate: 06/20/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XMD0000048129TNY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


Home