Provider Demographics
NPI:1902538374
Name:BENAVENTE, ROSANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:BENAVENTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 COOLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7321
Mailing Address - Country:US
Mailing Address - Phone:828-712-0476
Mailing Address - Fax:
Practice Address - Street 1:1100 PEACHTREE ST NE STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4829
Practice Address - Country:US
Practice Address - Phone:404-445-5304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty