Basic Information
| Provider Information | |||||||||
| NPI: | 1174782205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COULTER | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 CONTINENTAL PLACE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370271073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158152517 | ||||||||
| FaxNumber: | 8447147189 | ||||||||
| Practice Location | |||||||||
| Address1: | 2693 FOREST HILLS RD SW | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WILSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278938611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522342841 | ||||||||
| FaxNumber: | 2522349270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 06/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | LL30873 | SC | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.