Provider Demographics
NPI:1700250107
Name:BENOIT, CORNELIA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:BENOIT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 LANEY WALKER BLVD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2960
Mailing Address - Country:US
Mailing Address - Phone:706-721-5931
Mailing Address - Fax:706-721-5945
Practice Address - Street 1:702 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GIBSON
Practice Address - State:GA
Practice Address - Zip Code:30810-4014
Practice Address - Country:US
Practice Address - Phone:706-598-3359
Practice Address - Fax:478-864-1288
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN186686OtherGEORGIA LICENSE