Individual
GERALD WILLIAM BENNETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10905 PROVIDENCE RD W, STE G200, CHARLOTTE, NC 28277-1538
(980) 488-4900
(980) 488-4905
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(980) 488-4900
(980) 488-4905
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
LL39578
SC
208M00000X
Hospitalist Physician
Primary
2023-03354
NC
Other
Enumeration date
06/30/2016
Last updated
04/24/2024
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