Healthcare Provider Details

I. General information

NPI: 1598528424
Provider Name (Legal Business Name): ACH MARTIN-BENNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 WATKINS AVE BLDG 9052
FORT MOORE GA
31905-5529
US

IV. Provider business mailing address

8830 WATKINS AVE BLDG 9052
FORT BENNING GA
31905-5529
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-1906
  • Fax: 762-408-2239
Mailing address:
  • Phone: 706-544-1907
  • 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 Code341800000X
TaxonomyMilitary/U.S. Coast Guard Transport
License Number
License Number State

VIII. Authorized Official

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