Healthcare Provider Details

I. General information

NPI: 1831631464
Provider Name (Legal Business Name): CHRISTEN MICHELLE BENTON CSFA, CST, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISSY BENTON CSFA

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 DALLAS ACWORTH HWY STE 103-14
DALLAS GA
30132-9300
US

IV. Provider business mailing address

10175 DALLAS ACWORTH HWY STE 103-14
DALLAS GA
30132-9300
US

V. Phone/Fax

Practice location:
  • Phone: 678-481-1647
  • Fax: 770-336-6620
Mailing address:
  • Phone: 678-481-1647
  • Fax: 770-336-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: