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General NPI Number Information
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NPI Number | 1912105164
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Entity Type | Individual
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Provider Name | BENJAMIN THOMAS HENNESSEE PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 100 W PARKVIEW DR
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City | HENDERSON
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State | NC
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Zip | 27536-5923
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Country | US
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Telephone | 252-438-3549
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Fax | 252-438-2084
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Provider Business Mailing Address
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Address Line | 508 HARDSCRABBLE DR
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-9767
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Country | US
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Telephone | 301-318-6688
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010--02477
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License Number State | NC
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