Healthcare Provider Details

I. General information

NPI: 1700250107
Provider Name (Legal Business Name): CORNELIA BENOIT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W MAIN ST
GIBSON GA
30810-4014
US

IV. Provider business mailing address

950 LANEY WALKER BLVD
AUGUSTA GA
30901-2960
US

V. Phone/Fax

Practice location:
  • Phone: 706-598-3359
  • Fax: 478-864-1288
Mailing address:
  • Phone: 706-721-5931
  • Fax: 706-721-5945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN186686
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: