Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1245850452 |
---|---|
Provider Name | Christina Antoinette Benjamin |
First Address | Atlanta, GA 31146-7271 |
Second Address | Roswell, GA 30076-4715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2020 |
Last Update Date | 17/04/2020 |