Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | DPH000003 | GA |
N | 1223G0001X | General Practice | 8209 | NC |
N | 213EG0000X | General Practice | 8209 | NC |
Y | 1223G0001X | General Practice | DN013634 | GA |
Y | 213EG0000X | General Practice | DN013634 | GA |
NPI | 1235210303 |
---|---|
Provider Name | Dr. Gerald Mitchell Benson JR. |
First Address | Savannah, GA 31405-4504 |
Second Address | Savannah, GA 31405-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 21/08/2007 |