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Individual
BRIAN NATHAN BENNETT
Active
Individual
BRIAN NATHAN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD000842
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000812985C
—
GA
05
—
00812985B
—
GA
01
—
2592457
AETNA HMO
GA
01
—
2700070
UNITED HEALTHCARE
GA
01
—
4292280003
MEDICARE PTAN
GA
01
—
480032159
RAILROAD MEDICARE
GA
01
—
7052274
BCBS OF GEORGIA
GA
01
—
7104253
AETNA PPO
GA
01
—
GPD842
SOUTH CAROLINA MEDICAID
SC
Enumeration date
09/15/2006
Last updated
06/17/2019
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