Healthcare Provider Details

I. General information

NPI: 1487093738
Provider Name (Legal Business Name): JENNA M BENSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HIGHMARKET ST STE 200
GEORGETOWN SC
29440-3227
US

IV. Provider business mailing address

90 CEDAR LIGHT LN
LITTLE RIVER SC
29566-6978
US

V. Phone/Fax

Practice location:
  • Phone: 843-546-8421
  • Fax: 843-546-1173
Mailing address:
  • Phone: 843-280-8779
  • Fax: 843-280-6669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number191953
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1487093738
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number51498
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: