Healthcare Provider Details

I. General information

NPI: 1184382715
Provider Name (Legal Business Name): ACH MARTIN-BENNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6998 OLD CUSSETA RD
FORT BENNING GA
31905-5431
US

IV. Provider business mailing address

6976 OLD CUSSETA RD BUILDING 4202 ROOM 005V
FORT BENNING GA
31905-5431
US

V. Phone/Fax

Practice location:
  • Phone: 706-626-1620
  • Fax: 706-626-1621
Mailing address:
  • Phone: 706-686-1620
  • Fax: 762-408-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650