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General NPI Number Information
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NPI Number | 1588925853
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Entity Type | Organization
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Legal Business Name | ELLEN M BENSON LLC
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 345 BOULEVARD NE SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30312-1216
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Country | US
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Telephone | 404-604-3700
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Fax | 404-604-3705
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Provider Business Mailing Address
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Address Line | 762 WEYBOURNE CT
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City | MARIETTA
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State | GA
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Zip | 30066-4804
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Country | US
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Telephone | 404-242-1962
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Fax | 404-604-3705
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELLEN M BENSON
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Credential | MSN, APRN, BC
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Telephone | 404-242-1962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | RN110079
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License Number State | GA
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