Provider Demographics
NPI:1629010012
Name:FOLK, BENJAMIN PERRY III (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:PERRY
Last Name:FOLK
Suffix:III
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 1:1502 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7219
Mailing Address - Country:US
Mailing Address - Phone:662-332-9872
Mailing Address - Fax:662-378-0290
Practice Address - Street 1:1502 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7219
Practice Address - Country:US
Practice Address - Phone:662-332-9872
Practice Address - Fax:662-378-0290
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS060024546OtherRR MEDICARE
MS4376234OtherAETNA PIN
MS0016500Medicaid
MS112656001OtherAR MEDICAID
MS060000014Medicare PIN