Individual
ADAM BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12 PARK PL # 254, HATTIESBURG, MS 39402-1429
(954) 559-2171
Mailing address
12 PARK PL # 254, HATTIESBURG, MS 39402-1429
(954) 559-2171
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0635
MS
Other
Enumeration date
04/02/2014
Last updated
04/02/2014
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