MEDICARE: MS. ANNE MICHELE BENFORD NP

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	2080A0000X	Pediatric Adolescent Medicine Physician	RN119911	GA

General Provider Information

NPI Number	:	1831843499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE MICHELE BENFORD NP

Provider Business Mailing Address
First Line	:	2240 W PARK PLACE BLVD STE A
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-3543
Country	:	US
Telephone Number	:	770-771-5222
Fax Number	:	770-771-5223

Provider Business Practice Location Address
First Line	:	2240 W PARK PLACE BLVD STE A
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-3543
Country	:	US
Telephone Number	:	770-771-5222
Fax Number	:

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

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	02/11/2022

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