Individual
DAMEA B BENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 MEDICAL PARK, HATTIESBURG, MS 39401
(601) 579-3000
(601) 579-5240
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-3735
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
13507
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120423
—
MS
01
—
1559116
AMERICAN ADMIN GROUP
MS
05
—
1595144
—
LA
Enumeration date
07/27/2006
Last updated
07/14/2020
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