Healthcare Provider Details

I. General information

NPI: 1487263034
Provider Name (Legal Business Name): NICHOLAS BENDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 CALIBRE XING NW STE 1225
ACWORTH GA
30101-4135
US

IV. Provider business mailing address

4450 CALIBRE XING NW STE 1225
ACWORTH GA
30101-4135
US

V. Phone/Fax

Practice location:
  • Phone: 770-491-5481
  • Fax: 770-491-5482
Mailing address:
  • Phone: 770-491-5481
  • Fax: 770-491-5482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number103050
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: