Individual
MISS BENITA MERIN MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAA
Contact information
Practice address
575 PROFESSIONAL DR, #165, LAWRENCEVILLE, GA 30046-3333
(770) 277-3056
Mailing address
575 PROFESSIONAL DR, #165, LAWRENCEVILLE, GA 30046-3333
(770) 277-3056
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
7853
GA
Other
Enumeration date
01/11/2016
Last updated
01/11/2016
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