Provider Demographics
NPI:1750270229
Name:BENVENISTE, MACI
Entity type:Individual
Prefix:
First Name:MACI
Middle Name:
Last Name:BENVENISTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 ARTHURS CT NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5203
Mailing Address - Country:US
Mailing Address - Phone:404-729-8888
Mailing Address - Fax:
Practice Address - Street 1:1357 HEMBREE RD STE 250
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5724
Practice Address - Country:US
Practice Address - Phone:770-754-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical