Provider Demographics
NPI:1174782205
Name:COULTER, BENJAMIN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LEE
Last Name:COULTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CONTINENTAL PLACE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1073
Mailing Address - Country:US
Mailing Address - Phone:615-815-2517
Mailing Address - Fax:844-714-7189
Practice Address - Street 1:2693 FOREST HILLS RD SW
Practice Address - Street 2:SUITE B
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8611
Practice Address - Country:US
Practice Address - Phone:252-234-2841
Practice Address - Fax:252-234-9270
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL30873207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology