Provider Demographics
NPI:1831375088
Name:BNEJAMIN, MARGUERITA (LPN)
Entity type:Individual
Prefix:
First Name:MARGUERITA
Middle Name:
Last Name:BNEJAMIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 MCCLURE BRIDGE RD STE C301
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8706
Mailing Address - Country:US
Mailing Address - Phone:404-839-3631
Mailing Address - Fax:404-920-4782
Practice Address - Street 1:3400 MCCLURE BRIDGE RD STE C301
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8706
Practice Address - Country:US
Practice Address - Phone:404-839-3631
Practice Address - Fax:404-920-4782
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101Y00000X
GALPN067457164W00000X
GA376J00000X, 372600000X, 172V00000X, 374U00000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
No172V00000XOther Service ProvidersCommunity Health Worker
No374U00000XNursing Service Related ProvidersHome Health Aide
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral