Provider Demographics
NPI:1548765944
Name:THORNTON, BENJAMIN DOUGLAS
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DOUGLAS
Last Name:THORNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:DOUGLAS
Other - Last Name:THORNTON-FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR STE 500
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8159
Mailing Address - Country:US
Mailing Address - Phone:770-941-7717
Mailing Address - Fax:
Practice Address - Street 1:1700 HOSPITAL SOUTH DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6810
Practice Address - Country:US
Practice Address - Phone:770-941-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104867207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology