Provider Demographics
NPI:1992829717
Name:INTERNAL MEDICINE ASSOCIATES OF JOHNS CREEK
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF JOHNS CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-474-9633
Mailing Address - Street 1:3905 JOHNS CREEK COURT
Mailing Address - Street 2:200
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-474-9633
Mailing Address - Fax:678-474-9635
Practice Address - Street 1:3905 JOHNS CREEK COURT
Practice Address - Street 2:200
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:678-474-9633
Practice Address - Fax:678-474-9635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID
GAH61092Medicare UPIN
GA=========OtherTAX ID