Provider Demographics
NPI:1245850452
Name:BENJAMIN, CHRISTINA ANTOINETTE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANTOINETTE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 467271
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31146-7271
Mailing Address - Country:US
Mailing Address - Phone:248-986-8761
Mailing Address - Fax:
Practice Address - Street 1:1570 HOLCOMB BRIDGE RD STE 205
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4715
Practice Address - Country:US
Practice Address - Phone:248-986-8761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty