Provider Demographics
NPI:1790959799
Name:BENOIT, PEGGY (LPN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:BENOIT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MADISON STREET
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813
Mailing Address - Country:US
Mailing Address - Phone:706-910-0056
Mailing Address - Fax:
Practice Address - Street 1:COMMANDER DDEAMC
Practice Address - Street 2:CONNELLY HEATH CLINIC ATTN: MCHF-DFCM-CHC
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074112164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse