Provider Demographics
NPI:1780407197
Name:MAXWELL, BENJAMIN CHIJIOKE
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CHIJIOKE
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 PALETTE LN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4035
Mailing Address - Country:US
Mailing Address - Phone:678-558-2999
Mailing Address - Fax:
Practice Address - Street 1:227 PALETTE LN
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4035
Practice Address - Country:US
Practice Address - Phone:678-558-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)