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General NPI Number Information
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NPI Number | 1023769965
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Entity Type | Individual
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Provider Name | ASHLEY BENITEZ
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Gender | Female
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1009 ALABAMA AVE S
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City | BREMEN
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State | GA
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Zip | 30110-2501
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Country | US
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Telephone | 678-821-6400
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Fax | 678-821-6401
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Provider Business Mailing Address
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Address Line | 249 VALLEY DR
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City | BREMEN
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State | GA
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Zip | 30110-5435
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Country | US
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Telephone | 256-525-0834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-175802
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN278135
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License Number State | GA
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