Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 077352 | GA |
NPI | 1104113919 |
---|---|
Provider Name | Kaysi Benefield |
First Address | Carrollton, GA 30117-3857 |
Second Address | Villa Rica, GA 30180-1264 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 27/01/2017 |