Provider Demographics
NPI:1154383438
Name:BENEDICT, ALAN L (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:L
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 CHEROKEE ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8911
Mailing Address - Country:US
Mailing Address - Phone:770-419-1393
Mailing Address - Fax:770-419-8188
Practice Address - Street 1:653 CHEROKEE ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8911
Practice Address - Country:US
Practice Address - Phone:770-419-1393
Practice Address - Fax:770-419-8188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035371207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18BDCPL01Medicare ID - Type Unspecified
GAE52920Medicare UPIN