MEDICARE: A. BENJAMIN EUBANKS, MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP0016X	Prescribing (Medical) Psychologist	015460	GA

General Provider Information

NPI Number	:	1477814242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. BENJAMIN EUBANKS, MD, LLC

Provider Business Mailing Address
First Line	:	2751 BUFORD HWY NE
Second Line	:	SUITE 204
City	:	ATLANTA
State	:	GA
Zip	:	30324-3207
Country	:	US
Telephone Number	:	404-325-0100
Fax Number	:	404-237-9050

Provider Business Practice Location Address
First Line	:	2751 BUFORD HWY NE
Second Line	:	SUITE 204
City	:	ATLANTA
State	:	GA
Zip	:	30324-3207
Country	:	US
Telephone Number	:	404-325-0100
Fax Number	:	404-237-9050

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BENJAMIN EUBANKS
Credential	:	M.D.
Telephone Number	:	404-325-0100

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/07/2012

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