Basic Information
| Provider Information | |||||||||
| NPI: | 1558459933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENTON | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | RUFFIN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 5TH AVE E | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287924377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286924289 | ||||||||
| FaxNumber: | 8286961794 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 W FRENCH BROAD ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287124773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288835550 | ||||||||
| FaxNumber: | 8288835525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 10/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 18605 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01-70389 | 01 | NC | UNITED HEALTHCARE | OTHER | 15071 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 8915071 | 05 | NC | MEDICAID | 561852981E | 01 | NC | CIGNA | OTHER | 0637660001 | 01 | NC | PALMETTO GOVERNMENT SERVI | OTHER | 110012027 | 01 | NC | RAILROAD MEDICARE | OTHER |