Provider Demographics
NPI:1205802733
Name:BENIGNO, BENEDICT B (MD)
Entity type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:B
Last Name:BENIGNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:980 JOHNSON FY RD NE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:404-300-2990
Mailing Address - Fax:404-300-2986
Practice Address - Street 1:980 JOHNSON FY RD NE
Practice Address - Street 2:SUITE 130
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-300-2990
Practice Address - Fax:404-300-2986
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA017010207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000007246FMedicaid
D44841Medicare UPIN
GA16BDFTVXMedicare ID - Type Unspecified