Individual
KEELIA ELISE BENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6002 PROFESSIONAL PKWY STE 140, DOUGLASVILLE, GA 30134-5603
(678) 715-9690
Mailing address
625 OLD PEACHTREE RD NW, SUWANEE, GA 30024-2937
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10675
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/24/2021
Last updated
02/07/2026
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