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General NPI Number Information
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NPI Number | 1699157115
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Entity Type | Organization
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Legal Business Name | BENJAMIN RECORD WHITEHOUSE
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Dates
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Enumeration Date | 06/20/2015
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 303 PARKWAY DR NE
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City | ATLANTA
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State | GA
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Zip | 30312-1212
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Country | US
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Telephone | 434-229-5567
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Fax |
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Provider Business Mailing Address
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Address Line | 641 NORTH AVE NE APT 4101
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City | ATLANTA
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State | GA
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Zip | 30308-2846
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Country | US
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Telephone | 434-229-5567
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Fax |
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Authorized Official
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Title or Position | RESIDENT PHYSICIAN
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Name | DR. BENJAMIN RECORD WHITEHOUSE
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Credential | MD
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Telephone | 434-229-5567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 007624
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License Number State | GA
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