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General NPI Number Information
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NPI Number | 1831843499
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Entity Type | Individual
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Provider Name | ANNE MICHELE BENFORD NP
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Gender | Female
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 2240 W PARK PLACE BLVD STE A
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3543
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Country | US
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Telephone | 770-771-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 W PARK PLACE BLVD STE A
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3543
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Country | US
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Telephone | 770-771-5222
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Fax | 770-771-5223
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | RN119911
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License Number State | GA
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