Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CHIR009123 | GA |
NPI | 1407291461 |
---|---|
Provider Name | Benjamin Behrendt |
First Address | Marietta, GA 30067-4846 |
Second Address | Marietta, GA 30067-4846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2013 |
Last Update Date | 05/05/2013 |