MEDICARE: BENJAMIN MORRIS HANDY

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	101Y00000X	Counselor	001640	GA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	07130	IN

General Provider Information

NPI Number	:	1568767101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MORRIS HANDY

Provider Business Mailing Address
First Line	:	300 VILLAGE GREEN CIR SE
Second Line	:	SUITE 201
City	:	SMYRNA
State	:	GA
Zip	:	30080-3476
Country	:	US
Telephone Number	:	404-661-4954
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 VILLAGE GREEN CIR SE
Second Line	:	SUITE 201
City	:	SMYRNA
State	:	GA
Zip	:	30080-3476
Country	:	US
Telephone Number	:	404-661-4954
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	01/12/2011

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