Provider Demographics
NPI:1073526547
Name:CUNNINGHAM, BENNA ELLIS (APRN,BC)
Entity Type:Individual
Prefix:MRS
First Name:BENNA
Middle Name:ELLIS
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-1755
Mailing Address - Country:US
Mailing Address - Phone:706-542-8666
Mailing Address - Fax:706-542-0275
Practice Address - Street 1:370 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1755
Practice Address - Country:US
Practice Address - Phone:706-542-8666
Practice Address - Fax:706-542-0275
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN036369 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner