Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT002249 | GA |
Y | 213ES0000X | Sports Medicine | AT002249 | GA |
NPI | 1134546252 |
---|---|
Provider Name | Michael Benfield |
First Address | Gainesville, GA 30504-8111 |
Second Address | Atlanta, GA 30329-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 26/03/2014 |