Provider Demographics
NPI:1205886074
Name:BENSON, KATHRYN M (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:BENSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3497 DULUTH PARK LANE
Mailing Address - Street 2:STE 200
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:770-813-9775
Mailing Address - Fax:770-813-8976
Practice Address - Street 1:3497 DULUTH PARK LANE
Practice Address - Street 2:STE 200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-813-9775
Practice Address - Fax:770-813-8976
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA032695208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E85749Medicare UPIN