Healthcare Provider Details

I. General information

NPI: 1205802733
Provider Name (Legal Business Name): BENEDICT B BENIGNO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FY RD NE SUITE 130
ATLANTA GA
30342-1626
US

IV. Provider business mailing address

980 JOHNSON FY RD NE SUITE 130
ATLANTA GA
30342-1626
US

V. Phone/Fax

Practice location:
  • Phone: 404-300-2990
  • Fax: 404-300-2986
Mailing address:
  • Phone: 404-300-2990
  • Fax: 404-300-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number017010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: