Individual
MARK BENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4176 CHATFORD CV, TUCKER, GA 30084-7907
(404) 552-3540
Mailing address
4176 CHATFORD CV, TUCKER, GA 30084-7907
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
RN284420
GA
207R00000X
Internal Medicine Physician
RN284420
GA
Other
Enumeration date
08/21/2019
Last updated
08/21/2019
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