Provider Demographics
NPI:1902673858
Name:BENSON, GINEARA B
Entity type:Individual
Prefix:
First Name:GINEARA
Middle Name:B
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GINEARA
Other - Middle Name:B
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TUCKEM HOME CARE LLC
Mailing Address - Street 1:2385 WALL ST SE STE 205
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2187
Mailing Address - Country:US
Mailing Address - Phone:678-964-2031
Mailing Address - Fax:
Practice Address - Street 1:2385 WALL ST SE STE 205
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2187
Practice Address - Country:US
Practice Address - Phone:678-964-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion