MEDICARE: BENE' MENTAL WELLNESS

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	2084P0804X	Child & Adolescent Psychiatry Physician	65921	GA

General Provider Information

NPI Number	:	1548550429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENE' MENTAL WELLNESS

Provider Business Mailing Address
First Line	:	805 MOUNT AUBURN ST APT 37
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-1544
Country	:	US
Telephone Number	:	615-504-6876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 SAVOY DR STE 101
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1073
Country	:	US
Telephone Number	:	770-234-0981
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CANDACE BENE' ADAIR
Credential	:	M.D.
Telephone Number	:	615-504-6876

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	04/13/2011

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