| Ellen M Benson Llc | |
|
345 Boulevard Ne Suite 100 Atlanta GA 30312-1216 | |
| (404) 604-3700 | |
| (404) 604-3705 |
| Full Name | Ellen M Benson Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 345 Boulevard Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Ellen M Benson (OWNER) |
| Authorized Official Contact | 4042421962 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellen M Benson Llc 762 Weybourne Ct Marietta GA 30066-4804 Ph: (404) 242-1962 | Ellen M Benson Llc 345 Boulevard Ne Suite 100 Atlanta GA 30312-1216 Ph: (404) 604-3700 |
| NPI Number | 1588925853 |
|---|---|
| Provider Enumeration Date | 06/04/2012 |
| Last Update Date | 05/17/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588925853 | NPI | - | NPPES |
| 202G704527 | Other | GA | MEDICARE PTAN |
| 455012559A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | RN110079 (Georgia) | Primary |
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