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General NPI Number Information
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NPI Number | 1508886698
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Entity Type | Individual
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Provider Name | CAMMY RENAE BENTON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 1985 STARTOWN RD SUITE 102
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City | HICKORY
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State | NC
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Zip | 28602-8307
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Country | US
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Telephone | 828-327-4745
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Fax | 828-322-3569
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Provider Business Mailing Address
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Address Line | PO BOX 890273
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City | CHARLOTTE
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State | NC
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Zip | 28289-0273
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Country | US
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Telephone | 828-327-4745
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Fax | 828-322-3569
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2003-01203
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License Number State | NC
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