Healthcare Provider Details

I. General information

NPI: 1255501466
Provider Name (Legal Business Name): BENEVIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 NORTHCHASE PKWY SE SUITE 150
MARIETTA GA
30067-6405
US

IV. Provider business mailing address

1090 NORTHCHASE PKWY SE SUITE 150
MARIETTA GA
30067-6405
US

V. Phone/Fax

Practice location:
  • Phone: 770-916-5028
  • Fax:
Mailing address:
  • Phone: 770-916-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANDREW OREFFICE
Title or Position: VICE PRESIDENT
Credential:
Phone: 770-916-5021