Organization
ELLEN M BENSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELLEN M BENSON MSN, APRN, BC (OWNER)
(404) 242-1962
Entity
Organization
Contact information
Practice address
345 BOULEVARD NE, SUITE 100, ATLANTA, GA 30312-1216
(404) 604-3700
(404) 604-3705
Mailing address
762 WEYBOURNE CT, MARIETTA, GA 30066-4804
(404) 242-1962
(404) 604-3705
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
RN110079
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G704527
MEDICARE PTAN
GA
05
—
455012559A
—
GA
Enumeration date
06/04/2012
Last updated
05/17/2013
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