MEDICARE: DR. TANEISHA NACOYA BENJAMIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	71450	GA
2	207RN0300X	Nephrology Physician	071450	GA
3	207R00000X	Internal Medicine Physician	074150	GA

General Provider Information

NPI Number	:	1184881674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANEISHA NACOYA BENJAMIN M.D.

Provider Business Mailing Address
First Line	:	1192 ROCKBRIDGE RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-2923
Country	:	US
Telephone Number	:	770-925-2010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1192 ROCKBRIDGE RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-2923
Country	:	US
Telephone Number	:	770-925-2010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	08/01/2022

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