Healthcare Provider Details

I. General information

NPI: 1205730082
Provider Name (Legal Business Name): KATELYN BENEITO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 CANTON RD STE 112
MARIETTA GA
30066-3955
US

IV. Provider business mailing address

3208 CANTON RD STE 112
MARIETTA GA
30066-3955
US

V. Phone/Fax

Practice location:
  • Phone: 770-800-2070
  • Fax:
Mailing address:
  • Phone: 770-800-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332323
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: