KAISSA DESTA BENTH

CANTON, GA
NPI1942955323
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: GA  227597)
Enumeration Date2022-02-15
Last Update Date2022-02-15
Business Address
KAISSA DESTA BENTH NP
1558 MARIETTA HWY
CANTON, GA 30114-3616
Phone number: 470-259-0444
Mailing Address
KAISSA DESTA BENTH NP
PO BOX 2491
ACWORTH, GA 30102-0009
Phone number:
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