Healthcare Provider Details

I. General information

NPI: 1457828220
Provider Name (Legal Business Name): ANDREW SCOTT BENESH PHD LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MARTIN LUTHER KING JR BLVD
MACON GA
31201-3490
US

IV. Provider business mailing address

250 MARTIN LUTHER KING JR BLVD
MACON GA
31201-3490
US

V. Phone/Fax

Practice location:
  • Phone: 478-301-4111
  • Fax:
Mailing address:
  • Phone: 478-301-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: