Healthcare Provider Details

I. General information

NPI: 1306485198
Provider Name (Legal Business Name): ORLANE BENAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2019
Last Update Date: 06/20/2021
Certification Date: 06/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 TOWN CENTER VILLAGE DR APT 1227
MCDONOUGH GA
30253-5932
US

IV. Provider business mailing address

135 BISCAYNE TER
HAMPTON GA
30228-3537
US

V. Phone/Fax

Practice location:
  • Phone: 404-747-8811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT013560
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: