Provider Demographics
NPI:1023731148
Name:FLEENOR, GABRIELLE MORGAN-BENEDETTO
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:MORGAN-BENEDETTO
Last Name:FLEENOR
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 1:623 JUNIPER LN APT 623
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-7648
Mailing Address - Country:US
Mailing Address - Phone:207-877-4357
Mailing Address - Fax:
Practice Address - Street 1:623 JUNIPER LN APT 623
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-7648
Practice Address - Country:US
Practice Address - Phone:207-877-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant