Healthcare Provider Details

I. General information

NPI: 1194730846
Provider Name (Legal Business Name): ACH MARTIN-BENNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD BLDG 9250
FORT BENNING GA
31905-2102
US

IV. Provider business mailing address

6600 VAN AALST BLVD BLDG 9250 ATTN UNIFORM BUSINESS OFFICE
FORT BENNING GA
31905-2102
US

V. Phone/Fax

Practice location:
  • Phone: 762-408-2273
  • Fax:
Mailing address:
  • Phone: 762-408-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: GLORIA TAYLOR
Title or Position: UBO MANAGER
Credential:
Phone: 762-408-2461