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NPI Code Detail

MEDICARE: CORAL ROCHELLE BENGE PA-C

MEDICARE: CORAL ROCHELLE BENGE PA-C
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
1363A00000XPhysician Assistant003067GA

General Provider Information

NPI Number : 1922040781
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORAL ROCHELLE BENGE PA-C
Provider Business Mailing Address
First Line : 1631 HIGHWAY 20 W
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-7311
Country : US
Telephone Number : 678-583-0241
Fax Number : 678-583-0261
Provider Business Practice Location Address
First Line : 1631 HIGHWAY 20 W
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-7311
Country : US
Telephone Number : 678-583-0241
Fax Number : 678-583-0261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 11/08/2011

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Directions to “ CORAL ROCHELLE BENGE PA-C” Practice Location

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