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NPI Code Detail

MEDICARE: CHRISTINE MARIE BETHENCOURT

MEDICARE: CHRISTINE MARIE BETHENCOURT
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
1208000000XPediatrics PhysicianMT228539PA

General Provider Information

NPI Number : 1942969001
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE MARIE BETHENCOURT
Provider Business Mailing Address
First Line : 525 NORTH AVE NE UNIT 520
Second Line :
City : ATLANTA
State : GA
Zip : 30308-8020
Country : US
Telephone Number : 305-967-9514
Fax Number :
Provider Business Practice Location Address
First Line : 80 JESSE HILL JR DR SE
Second Line :
City : ATLANTA
State : GA
Zip : 30303-3050
Country : US
Telephone Number : 305-967-9514
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2021
Last Update Date : 06/08/2023

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Directions to “ CHRISTINE MARIE BETHENCOURT ” Practice Location

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