Healthcare Provider Details

I. General information

NPI: 1215550025
Provider Name (Legal Business Name): JAVIER BENITEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE BLDG A4TH
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE BLDG A4TH
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3712
  • Fax: 404-778-5033
Mailing address:
  • Phone: 404-778-3712
  • Fax: 404-778-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11344
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: