Provider Demographics
NPI:1487093738
Name:BENSON, JENNA M (MD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:BENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 CEDAR LIGHT LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-6978
Mailing Address - Country:US
Mailing Address - Phone:843-280-8779
Mailing Address - Fax:843-280-6669
Practice Address - Street 1:1200 HIGHMARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3227
Practice Address - Country:US
Practice Address - Phone:843-546-8421
Practice Address - Fax:843-546-1173
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC191953207R00000X
NC1487093738207W00000X
SC51498207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC514982Medicaid