Provider Demographics
NPI:1720522600
Name:HERRON, BENJAMIN ROBERT (CSFA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:HERRON
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 KENNESAW AVE NW STE 120
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1052
Mailing Address - Country:US
Mailing Address - Phone:470-336-8190
Mailing Address - Fax:770-336-6620
Practice Address - Street 1:800 KENNESAW AVE NW STE 120
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:470-336-8190
Practice Address - Fax:770-336-6620
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2018-05-31
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical