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General NPI Number Information
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NPI Number | 1477814242
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Entity Type | Organization
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Legal Business Name | A. BENJAMIN EUBANKS, MD, LLC
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 2751 BUFORD HWY NE SUITE 204
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City | ATLANTA
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State | GA
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Zip | 30324-3207
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Country | US
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Telephone | 404-325-0100
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Fax | 404-237-9050
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Provider Business Mailing Address
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Address Line | 2751 BUFORD HWY NE SUITE 204
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City | ATLANTA
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State | GA
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Zip | 30324-3207
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Country | US
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Telephone | 404-325-0100
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Fax | 404-237-9050
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Authorized Official
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Title or Position | PRESIDENT
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Name | BENJAMIN EUBANKS
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Credential | M.D.
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Telephone | 404-325-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 015460
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License Number State | GA
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