Individual
STACI THOMAS BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5430 BOWMAN RD, MACON, GA 31210-8879
(478) 743-7068
(478) 741-1354
Mailing address
5430 BOWMAN RD, MACON, GA 31210-8879
(478) 743-7068
(478) 741-1354
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN-NP193050
GA
Other
Enumeration date
04/16/2020
Last updated
06/01/2026
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