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NPI Code Detail

MEDICARE: DR. MARNETTE ANN BENDER PH.D.

MEDICARE: DR. MARNETTE ANN BENDER PH.D.
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
1103TC0700XClinical PsychologistPSY002875GA

General Provider Information

NPI Number : 1962408294
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARNETTE ANN BENDER PH.D.
Provider Business Mailing Address
First Line : 118 E TRINITY PL
Second Line : SUITE 100
City : DECATUR
State : GA
Zip : 30030-3302
Country : US
Telephone Number : 404-518-1018
Fax Number : 770-962-1886
Provider Business Practice Location Address
First Line : 118 E TRINITY PL
Second Line : SUITE 100
City : DECATUR
State : GA
Zip : 30030-3302
Country : US
Telephone Number : 404-518-1018
Fax Number : 770-962-1886
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 02/28/2011

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